This graphic compares how financial assistance for out-of-pocket health care costs changes when individuals move into Medicare from health insurance marketplace coverage or their state’s expanded Medicaid program.
The Affordable Care Act (ACA) improved insurance affordability and access for all Americans, including those eligible for Medicare, Medicaid, and private coverage offered through the health insurance marketplace. It strengthened Medicare in many ways — by closing the Part D prescription drug doughnut hole, offering free preventive services, and extending the life of the Medicare trust fund. However, the ACA’s improvements to Medicaid and private market insurance highlight longstanding shortfalls in programs that assist low-income Medicare beneficiaries with their health care costs.
Today, July 30, we celebrate the 49th anniversary of one of the federal government’s most critical social insurance programs: Medicare. As the primary source of health coverage for 41 million older adults and 9 million people with disabilities, Medicare makes a huge difference in people’s lives and well-being. For the vast majority of beneficiaries, Medicare works well, and consumers are very satisfied with the health care they receive. But there is always room for improvement: Making it easier for low-income people to afford their out-of-pocket health care costs would make a good program even better.
Last week, Paul Ryan—House Budget Chairman and the likely incoming chairman of the powerful Ways and Means Committee—released a plan proposing the broad reform and streamlining of the nation’s safety net programs for the poor. Tellingly, the plan (an outline that is reportedly intended to portray a softer side of conservatism) sidesteps the budget proposals put forth by Ryan over the past four years that have actually been voted on and passed by the Republican-led House.
Four Strategies for Improving Programs that Help Low-Income Medicare Beneficiaries with Health Care Costs
Low-income people with Medicare often struggle with high out-of-pocket health care costs. This brief identifies four strategies that advocates and policymakers can use to improve the programs that help these beneficiaries.
Congress Should Vote to Make Permanent Two Federal Programs Benefitting Low-Income Families and Individuals
Unless Congress acts quickly, funding for two federal health programs that are critical to low-income families will expire on March 31. Both the Qualified Individual (QI) program and the Transitional Medical Assistance (TMA) program are integral to providing health care to families transitioning from welfare to work and to helping low-income seniors pay their Medicare monthly premiums. Making both programs permanent is the best way to ensure that these small but important programs continue to meet the needs of the individuals who rely on them.
Explains the Qualified Individual (QI) program and provides a 50-state look at how people benefit, including how many people get help and how much money QI puts in their pockets.
A recent report from the Government Accounting Office (GAO) points to one more reason why expanding health coverage under the Affordable Health Care Act (ACA) makes good economic sense. Expanding Medicaid can eliminate gaps in the health coverage of those who eventually enroll in Medicare. This drives down Medicare’s costs because enrollees tend to enroll in the program in better health.
More than 450,000 low-income Medicare beneficiaries rely on a little-known program called the Qualified Individual (QI) program to pay for their Medicare Part B premium. Without QI, they would face more than $100 per month in additional health care premiums. Currently, QI is a temporary program. Since Congress will be determining the future of QI over the next few months as it considers major Medicare legislation, this is an excellent opportunity improve QI by making it permanent.