Medicare Under Joe Biden and his Administration
With Joe Biden soon to be inaugurated as president what can we expect in the way of changes to the Medicare program? We heard a lot of promises around health care in the Democratic primary campaign, but compared to some of his fellow Democratic nominees, Biden has always taken a more moderate position on health care, preferring to work with systems already in place rather than push for a major overhaul of the way health care is delivered and financed in this country.
Biden will be working with the 117th Congress. Democrats now hold a majority in both chambers if you count vice president Kamala Harris’s tie-breaking vote in the Senate. However, neither chamber has a supermajority of two-thirds. This means any significant legislation will need to be bipartisan in order to pass. It will still be possible to pass certain legislation through the reconciliation process which requires a simple majority. Although such legislation has to be budget-related in order to meet requirements under the Byrd Rule, this should not be too difficult since most Medicare changes would have an impact on the federal budget. Still, Biden is not expected to try to force through any dramatic changes. Covid is his highest priority right now.
To start, Biden has nominated Xavier Becerra to replace Alex Azar as Secretary of Health and Human Services. As the attorney general of California, Becerra has been at the forefront of legal efforts on health care, working to protect the Affordable Care Act and fighting for women’s health. He is seen as somewhat partisan due to his aggressive actions on the ACA and his support for Medicare for All, however he has said he will be working to administer Biden’s agenda even if different from his own. If confirmed, he will be the first Latino to lead HHS.
Biden has not yet named a new administrator for the Centers for Medicare and Medicaid Services (CMS). This will be an important role in Biden’s overall plan to expand health care coverage. A number of former Obama officials are under consideration.
As for Medicare, the challenge is huge: balancing retirees’ needs for continued coverage in light of rising health care costs, and the looming exhaustion of the HI (Part A) Trust Fund in 2024. Specifically, Biden has talked about two major changes: lowering the Medicare eligibility age to 60, and authorizing Medicare to negotiate drug prices, the latter being a promise of President Trump which never came to fruition.
Lower the Medicare eligibility age to 60?
Lowering the Medicare eligibility age to 60 would cover that crucial period of time between age 60 and 64 when many people would like to retire but are not yet eligible for Medicare. There are about 23 million people in this age range. Not all of them would enroll in Medicare, of course. The 1.7 million who have no insurance and the 3.2 million who buy insurance on the ACA exchange would be the most likely to enroll at 60 if eligible. Of the 13 million who have employer coverage, some would be expected to keep it, some would take this opportunity to retire and drop it in favor of Medicare, and some might continue with the employer coverage and add Medicare as a wrap-around policy.
Bringing more people into the program would strengthen Medicare’s clout in the marketplace when it comes to negotiating prices with providers and hospitals. Bringing younger people into the program would lower the average cost per beneficiary, but it would still cost the government as much as $200 billion over the next decade depending on what other reforms are made around the ACA.
Although popular among Americans, the proposal faces an uphill battle, primarily from hospitals, who would lose billions of dollars in revenue due to Medicare’s lower fee structure. Medicare reimbursement rates for patients admitted to hospitals average half what commercial or employer-sponsored insurance plans pay. The American Hospital Association is one of the biggest lobbies in Congress.
Negotiate drug prices?
Part of the deal President George W. Bush made with drugmakers in passing the Medicare Modernization Act was that the federal government would not negotiate drug prices. This has come back to haunt the U.S, as drug prices have escalated dramatically. Higher drug prices have not only cost the Medicare program more—about $97 billion in 2019 compared to $44 billion in 2006—they also cost Medicare beneficiaries thousands of dollars in out-of-pocket spending, especially for high-cost specialty drugs.
Allowing the federal government to negotiate directly with drugmakers on price would save the program an estimated $456 billion between 2023 and 2029, according to the Congressional Budget Office. Drugmakers claim they need these revenues for research and clinical trials. Biden’s healthcare plan would also allow people to buy select prescription drugs from other countries. This would provide for a more competitive marketplace that should effectively lower prescription drug pricing.
Biden’s Medicare plan would prohibit drugmakers from raising the price of their therapies at a rate faster than inflation as a condition of Medicare participation. Drug developers that raise the costs of their prescription medicines faster the annual inflation rate would face a tax penalty.
While health care is a priority for President-Elect Biden, it’s understandable that non-Medicare issues, primarily the Covid vaccine rollout and the shoring up of the Affordable Care Act will come first. There’s a lot to do to ensure that all Americans have health care coverage. This will take time.
Get the extra benefits you deserve and save money on prescription drugs!
Imagine if you could save money on your prescriptions, have access to a large network of Scot’s and get coverage for extras that you may need that Medicare doesn’t cover. You deserve things like help paying for healthy food, a nutritional counselor, a home health aide, money to pay for assisted devices like bath railings and lift chairs. There are also benefits like help paying for pest control and much more!
LET US REVIEW YOUR DRUG COSTS AND BENEFITS TODAY. No obligation or cost! OPEN ENROLLMENT is only ONE time per year.
Medicare is healthcare for people 65 and older or that have been deemed disabled for at least 24 months by Social Security. Medicare covers health care aimed at serving an aging population. Coverage for items like hospitalization, skilled nursing care, home health care, doctor visits, emergency care and more are included in what Medicare covers. Medicare is regulated by the federal government and you can find out more about Medicare here.
Medicaid is health insurance with financial aid and is largely aimed at serving low income mothers, children, and disabled seniors. Each state has different rules and requirements regarding who may be eligible and what is covered. You can find out more here. Medicaid is regulated and funded by the federal and state government but each state is largely in charge of their own program. It is possible to be eligible for both programs at the same time. We can help you apply now!
Any time you move, contact your insurance agent no matter what your age to see if you need to change or SHOULD change plans.
Often, your time is limited to do this so it's important to contact your agent BEFORE you move so they can help you plan. Usually you only have 60 days and if you notify your current plan too soon, there is a chance they could automatically end your enrollment too soon.
DID YOU KNOW?
The USPS postal service is required to let insurers know (health and life insurance know) about a change of address? They are also required to let Social Security know.
If you are on Medicare, or are drawing Social Security, here is how you can easily submit an address change online. If you are not computer savvy, do not despair, simply call Social Security, at 1-800-772-1213, and they will take your address change over the phone.
Don't hesitate to ask us for assistance. That is why we are here.
Heather Majka, CSSCS (Certified Social Security Claiming Strategist)
Customers and I text all of the time. Usually for fun and friendliness. However, I often get serious questions via text/sms. Last night a Medicare client sent me this text.
Although it is not absolutely necessary the VA STRONGLY encourages you to sign up for Medicare Part B. You may also want to consider getting a Medicare Advantage or Supplement plan as well. This is especially the case for veterans that are NOT in priority group 1. There is no guarantee that Congress will approve VA funds to treat Veterans for Priority Groups 2-8.
Here are just a few reasons why Veterans may consider enrolling in a private Medicare Supplement or Advantage Insurance Plan:
Retirement saving plays an important role in the U.S. economy. Americans hold more than $18 trillion in private retirement accounts like 401(k)s and IRAs, while defined benefit pensions in the private and public sector hold trillions more. Social Security and Medicare comprise nearly 40 percent of the federal budget. The government also provides tax subsidies for retirement saving, and funds Medicaid, which covers elder long-term care. Yet despite existing research, policymakers do not have access to reliable data when making decisions that affect the retirement security of tens of millions of families. There are many major outstanding questions:
Making effective evidence-based policy requires both a comprehensive understanding of the policy challenge and attendant remedies, as well as the will and ability to implement the necessary reforms. The federal government should commission a large-scale panel survey that, coupled with linked administrative data, provides detailed information on household wealth, labor market, health and demographic data. No current data set provides such information.
You can find the full Retirement Security Project at Brookings paper here.
AARP reports thatAmericans are concerned and even afraid for their retirement security. And the news headlines often don’t make them feel better. The latest is a claim from the National institute for Retirement Security that “A plurality of older Americans, 40.2 percent, only receive income from Social Security in retirement.” If true that’s very worrying. But does this frightening factoid hold up?
The NIRS report’s data source is the Census Bureau’s Survey of Income and Program Participation (the SIPP). The SIPP surveys households by asking them a wide variety of questions, including the sources of their income. From the SIPP, NIRS declares that 40.2 percent of retirees receive all of their income from Social Security.
And yet, a 2017 study by researchers at the Social Security Administration, also using the SIPP, found that only 19.6% of Americans 65 and over received at least 90% of their total incomes from Social Security. That’s less than half the share of retirees than NIRS claims and SSA measures dependence using a lower bar—90% of total income rather than NIRS’s 100%. Clearly, there’s a conflict.
Moreover, a second 2017 study, from two Census Bureau economists, analyzed retirement incomes using IRS tax records, which are more accurate than households’ responses to a survey. The Census Bureau study found that only 12% of Americans aged 65+ received 90% or more of their income from Social Security. Again, it’s not clear how that is compatible with NIRS’s claim that over 40% of retirees receive all their income from Social Security.
From a policy perspective, one-fifth of retirees being heavily dependent on Social Security isn’t a huge problem: the poorest fifth of workers are indeed quite poor, and Social Security was designed to provide a retirement benefit for workers who can’t easily save on their own.
You can find the full article, including a discussion of why the NIRS data might be wrong, here.
According to AARP, one in 3 Tennesseans 67 and older are living on Social Security alone. To find out about poverty and the elderly learn more here.
On Friday, I drove to visit some upset clients who have been with me for over six years and are family members of other long time clients. They called me panicked after going to the pharmacy to pick up their medications the first time in 2020. Their prescription costs went from $22 per month in 2019 to $332 in 2020. I had called them a couple times and wrote them between the end of September through the December 2nd. We had spoken and they vowed to look at all the changes to their plan with me and call me back. Frankly, they had a lot going on in their family and had been happy with their plan for years. They figured it was a low priority, considering every other year we went through our review- I hadn’t ever recommended a change. Behind the scenes their 40 year old daughter who suffered from depression had hung herself and left behind three children and two grandchildren. GOOD NEWS in all of this was - they could still change their plan (until MARCH 31). They thanked me profusely for helping them choose a plan that allowed the best of care with minimal out of pocket expense when he went through an organ transplant and she simultaneously suffered from and survived breast cancer. Bottom line -I HELP HEAL AND CARE FOR FAMILIES, not SELL products or insurance.
Heather Majka, Certified Social Security Claiming Strategist, Owner of Citizens Insurance Solutions
With over 25 years of industry experience, Heather is a subject matter expert. Heather has two adult children serving in the US military (Naval Aircrew and US Army). Heather's husband is a US Army SNIPER Veteran that served during Desert Storm. Heather has is a native New Yorker who has lived in Virginia, Texas, Florida, and now lives in Tennessee.