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.
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.
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.
Explores why low-income people with Medicare struggle to pay for their health care and offers three ways to enable more Medicare beneficiaries to afford the care they need.
According to the Medicare Trustees’ report released last Friday, the Medicare hospital insurance trust fund (which covers the hospital portion of Medicare expenditures), is now fully funded until 2026. That’s two years longer than was estimated in last year’s report, and nine years longer than projections prior to enactment of the Affordable Care Act. But what’s more significant than the actual year cited in the report is the encouraging trend in Medicare’s costs that underlies the projection: Health care costs, and Medicare costs in particular, are growing more slowly than in the past. This is encouraging news for Medicare and for the 50 million seniors and people with disabilities who rely on it. If these trends continue, Medicare’s future fiscal challenges become significantly more manageable.
Since Medicare Part D went into effect in 2006, prescription drugs have been an integral part of the Medicare benefit package. So, the question of how seniors can save additional money on medications often comes up, but so does the question of how the entire Medicare Part D program can be more cost-effective and save taxpayers money without jeopardizing enrollee benefits.
For the third year in a row, the Republican majority in the House of Representatives has passed a budget proposal authored by Congressman Paul Ryan that transforms Medicare into a voucher system (also known as premium support). Starting in 2024, people born after 1958 would get a voucher to use toward either private insurance or traditional Medicare coverage. If the voucher is too small to buy adequate coverage, those who rely on Medicare will have to make up the difference with money out of their own pockets.