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Why Medicare Is Important

prescription drugs, Health Care Providers, Fair or Poor Health
June 6, 2022

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One in five elderly adults has limited income and lacks the flexibility to cover additional or unexpected medical expenses. The 6 billion elderly Americans in the United States depend upon Medicare to cover their medical costs. Medicare covers all people who need health insurance and provides protection against financial problems if illness hits the United States. Nevertheless, gaps in Medicare coverage may cause costly financial burdens.

Role of Medicare

In 1965 a federal law requiring Medicare provided basic insurance to most elderly Americans. Because Medicare covers all age groups it is impossible for an elderly person to have additional medical coverage and it is not possible for an elderly person to have any health coverage. Medicare facilitates the health of physicians and allows patients to get in and out of hospital whenever the need arises.

This ensures that the insurance for older people does not vary from place to place and does not restrict the elderly' choices of providers in the American healthcare system. Under the 2003 Medicare prescription Drug, Improvement, and Modernization Act (MMA), the Medicare Plus Choice program was relabeled as Medicare Advantage (MA), and MA plans now enroll more than one-third of Medicare beneficiaries.

Role of Medicaid

Medicaid provides affordable Medicare coverage to more than 40,000 Medicare dependent individuals with their Medicaid insurance policies. Medicaid coverage provides financial support to the most vulnerable and eligible people through a statewide health insurance plan that meets their income criteria. Medicaid pays the Medicare Part B premiums for beneficiaries whose total household income falls below 120 percent. Those who receive Medicaid as an alternative payment plan can also receive additional Medicare support, including prescription drug and LTTC.

Medicare beneficiaries

Under the 2003 Medicare prescription Drug, Improvement, and Modernization Act (MMA), the Medicare Plus Choice program was relabeled as Medicare Advantage (MA), and MA plans now enroll more than one-third of Medicare beneficiaries. Also in the MMA of 2003, reflecting the increased importance and costs of prescription drugs in treating both acute and chronic health care conditions, Congress enacted the Part D prescription drug benefit.

The Commonwealth Fund has a good overview of the measures that have been put in place to protect Medicare beneficiaries and providers during the COVID pandemic. Accountable Care Organizations (ACOs) are one example of a delivery system reform model currently being tested within Medicare.

With over 10 million assigned beneficiaries in 2018, ACO models allow groups of providers to accept responsibility for the overall care of Medicare beneficiaries and share in financial savings or losses depending on their performance in meeting spending and care quality targets.

Over time, however, fewer beneficiaries are expected to have this type of coverage, since the share of large firms offering retiree health benefits to their employees has dropped from 66 percent in 1988 to 18 percent in 2018.

Health care services

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs , like copayments, coinsurance, and deductibles. Benefit Gaps and Supplemental Coverage Medicare provides protection against the costs of many health care services, but traditional Medicare has relatively high deductibles and cost-sharing requirements and places no limit on beneficiaries' out-of-pocket spending for services covered under Parts A and B.

The law aims to expand Medicaid to more low-income people, and worked to cover the middle-range of citizens who made too much money to qualify for Medicaid but also could not afford to buy private insurance on their own.

Medicare is under attack and in danger of “withering on the vine”

Newt Gingrich predicted that privatization would leave Medicare rotting. Initially he argued that the plan would have to be repealed as soon as possible because beneficiaries would have to move to private coverage to get insurance. I think this is the truth of it all. Not just in random circumstances. It did not involve any crystals.

The process involved planning, vision and perseverance. Its mission is to help people find a way of life. We try every possible measure to ensure Medicare remains geared towards older people, not just the insurers. Characteristics of the Medicare Population What Medicare Covers Medicare covers many health services, including inpatient and outpatient hospital care, physician services, and prescription drugs

Medicare is a success: Preserving a Sound Program for Future Generations

Medicare has been successful. The program has been designed and implemented by the government in 1965 to cover social care for seniors who have not had adequate insurance. The Medicare program is a success story. It was designed and enacted in 1965 as a social insurance program because private companies failed to insure older people. It was intended to provide basic coverage through one health insurance system, with a defined set of benefits. Reforms to Medicare should honor and maintain its core values to ensure its continued success for future generations.

As stated by Nancy-Ann DeParle, a former Administrator of the Health Care Financing Administration (HCFA, now CMS):

Few programs in the history of the United States have brought as much benefit to society as Medicare. Since its enactment in 1965, Medicare has provided access to quality health care for those Americans least likely to be attractive to private insurers – those over age 65, disabled, or with end stage renal disease. Medicare has also prevented many Americans from slipping into poverty. The elderly’s poverty rate has declined dramatically since Medicare was enacted – from 29 percent in 1966 to 10.5 percent in 1995.

Medicare also provides security across generations: it has given American families assurance that they will not have to bear the full burden of health care costs of their elderly or disabled parents or relatives at the expense of their young families. (Preface, A Profile of Medicare, May 1998.)

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Medicare Platform: Principles to Improve Medicare for All Beneficiaries Now and In The Future

Defeat barriers that are persistent in healthcare. Improve traditional Medicare. Improves the Medicare system and simplifies Medicare. Do not privatize the whole process. Build this one more. Second, open the doors for the future. Among Medicare recipients, a median person spends $5,460 out of his own money to purchase medical services.

Currently MA plans have been over-repaid mainly by misrepresenting the risk adjustment payments and the faulty payment defined set of insurance services. Medicare reform should respect the company's basic beliefs and ensure the success of the next generation. In the past few decades, only one program in the United States had the benefits of Medicare for a person.

As private health insurance evolved to a more managed-care approach with an integrated benefit design, including both hospital and physician services, the Medicare Plus Choice program was enacted in 1997 with the addition of Medicare Part C that allowed Medicare HMOs to participate.

The Omnibus Budget Reconciliation Act of 1993 modified payments to Medicare providers. The Balanced Budget Act of 1997 significantly reduced provider payments to slow the growth in Medicare spending. It also established the Sustainable Growth Rate, which adjusted payment rates for doctors, and which Congress proceeded to patch 17 times.

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Impact of Insurance on Accessibility

Insurance protections for low-income elderly are crucial in helping to prevent financial barriers. Although Medicare coverage is universal, the ability for seniors to pay for Medicare costs-sharing requirements differs depending on their income level and their insurance supplement. Increasing access to healthcare in older adults is affecting access. One-quarter of Americans who are relying solely on health care insurance are poor or nearly poor.

Implications for the Future

In recent decades experience with Medicare as the main insurer and Medicaid as a supplement to the poor-age elderly, shows the need for affordable health insurance for seniors, as well as financial aid for those in the low-income bracket. Access to health and financial support are significantly greater for older adults who are covered jointly under Medicare and Medicaid.

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs , like copayments, coinsurance, and deductibles.


These writers belong to Henry Kaiser family foundations. The opinions expressed here are those of the authors but don’t necessarily represent the views of the Kaiser Family Foundation or of the Health Care Finance Administration. Figures are provided in the following table. Reprint requests: Barbara Lyons Henry J Kaiser Family Foundation.

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