A recent survey by Eligibility.com highlighted another problem with Medicare for All. Many Americans’ knowledge about Medicare is limited. They do know that Medicare is for the elderly and Medicaid is for the indigent – but I doubt they know that Medicare is a federally-funded reimbursement (not care management) program administered by Centers for Medicare and Medicaid Services (CMS), a federal agency. And IT IS DEFINITELY NOT FREE.
Medicare Part A, which covers basic hospitalization, is free for those who are eligible. However, Part B, which covers most other medical services is costly. Depending upon income, it can cost a Medicare recipient $135 to $460 per month. Part D, which covers prescription drugs through private insurers, is also not free. Costs vary significantly but average $33 per month in 2019. Part A and B both have deductibles and Medicare generally covers 80% of the Medicare allowable charge, but a provider can charge up to 115% of the Medicare rate that is set by CMS. So, many Medicare recipients purchase Medicare supplement plans (a.k.a. Medigap) which can cost hundreds of dollars more. All in, a Medicare recipient could pay as much as $1,000 per month for coverage which many people believe is free. And coverage for hospital and skilled nursing care is limited to a specified number of days. And there is no coverage for non-emergency care rendered outside of the United States.
And for those who think a public option is the answer, consider that the exchanges under ACA include many formerly Medicaid-only providers that have expanded their offering to individuals on the exchange. Medicaid is a state-federal partnership program and it generally is fully government-funded for income-based-eligible individuals and their dependents, but Medicaid providers on the exchanges are not free. Medicaid insurers have very limited provider networks and care is highly managed. This may be the direction for a “public option.”
Those that are embracing “Medicare For All” or the “Public Option” should learn the rules, costs and limitations of those programs. It may look like a shiny new toy, but that toy could have very sharp edges.