Senior Living Care Blog

What Seniors Need to Know About Medicare

Posted by Jackson Bentley on May 16, 2019 11:00:00 AM

As the next presidential elections begin to roll around, expect Medicare to become one of the most highly contentious issues debated amongst candidates. From Bernie Sander’s proposal of “Medicare for all” to Donald Trump’s campaign promises to repeal and replace Obamacare.

When it was first introduced by candidate Sanders in 2016, Medicare for all was considered a fringe proposal. Today however, he is joined by the likes of Elizabeth Warren, Cory Booker, and Kirsten Gillibrand. While the proposal is gaining popularity, one demographic may wind up being seriously undercut by the passage of Medicare for All.


The Medicare for all plan would establish a new Medicare-like program that covers everybody with no fees or out-of-pocket costs. However, this move would displace roughly 180 million people out of the private health care system, including many seniors. Many analysts believe that the disruption would be too much to be politically possible.


One assessment by Medicare trustees estimates that the program will start running short of money in 2026. Adding 180 million more people could put a serious strain on the American taxpayer to help cover debts. The administration plans on addressing the issue of healthcare by requiring the public posting of prices for prescription drugs and medical procedures so that patients can shop around for health care in much the same they browse other products and services.



Medicare’s Role in Reducing Senior Poverty

A home. An important thing to know about medicare is that it is helping to decrease senior poverty.

Even among those seniors who are currently not under private insurance, Medicare provides benefits to help keep them out of poverty. Currently, among Medicare beneficiaries with incomes below federal poverty levels, nearly 40% spend over 20% of their annual income on premiums and out-of-pocket medical expenses. To protect these seniors from high costs, it’s critical to address the underlying costs of healthcare by providing quality assurance for Medicare recipients.


Medicare's protections go to more than seniors. The program provides health coverage for 9.1 million disabled persons who in the past were typically unable to get approved for private insurance. Such individuals become eligible for Medicare if Social Security has classified them as disabled for 24 months. In addition, when Medicare was enacted in 1965 nearly 1 in 3 seniors lived in poverty. Older people were more likely to be poor than any other age group. Yet in its first 10 years, Medicare helped cut their poverty rate in half.


Medicare is an excellent resource for covering a wide variety of healthcare needs. Unlike Medicaid, which is based on income, medicare provides coverage for health insurance for anyone 65 or older and anyone with a disability severe enough to qualify, regardless of income level. However, understanding and making use of health insurance through Medicare can be confusing for many. Choosing your Medicare plan can also be difficult if you do not understand the differences between each plan. Medicare is broken into four parts: Part A, Part B, Part C, Part D. Each plan comprises different benefits and there are some services that Medicare will not cover at all.



Original Medicare

OG Medicare is the most commonly used form of Medicare coverage, comprised of Part A and Part B. Each part covers different types of healthcare services. Part A is Hospital Insurance while Part B covers Medical Insurance.


Part A: Hospital Insurance

The first part of OG Medicare is used to cover residential (or inpatient) stays, residency ina skilled nursing home, hospice care, and several home health services. Similar to other insurances, there are limitations, deductibles, co-insurance, and other out-of-pocket costs. Part A can be used without a premium if your senior has worked and paid social security taxes for at least 10 years. If not, then a monthly premium will apply. If you are considering using your senior’s Medicare to cover assisted living or a nursing home, keep in mind that custodial services are not covered by Medicare.


Part B: Medical Insurance

Part B of Medicare covers most medically necessary equipment, doctors, mental healthcare needs, outpatient services, and preventative care, as well as some health and ambulance services. As with Part A, a monthly premium may be required in order to receive coverage from Part B.



Why is Medicare Important for Seniors?

An older man sitting at lunch wonder why medicare is important for seniors.

One out of every five elderly Americans faces a limited income and little to no flexibility for unexpected medical expenses. When medical care is required, these 6 million or so elderly Americans depend on Medicare for helping to cover the costs of health expenses. Thanks to the universal coverage provided by Medicare, these seniors are assured access to America’s healthcare system with financial protection in case disaster strikes.


Medicare Scam Involving Seniors Busted in LA

On 4/30, Los Angeles authorities announced the break up of an over $1 billion Medicare scam that peddled hundreds of thousands of orthopedic braces to seniors via foreign call centers. The Justice Department formally announced charges against 24 people across the U.S., including doctors, call center owners, telemedicine firms, and medical equipment outlets. The case involved the FBI and 17 U.S. attorney offices, with arrests taking place Tuesday morning 4/30.


Over 130 medical equipment companies are still implicated in the scam, billing Medicare for upwards of $1.7 billion. The scam worked through telemarketers reaching out to seniors offering free orthopedic braces. These call centers were located in the Philippines and through Latin America.


These call centers would then confirm the senior’s Medicare coverage and transfer them to shell corporations posing as legitimate telemedicine companies. These legitimate doctors would simply write prescriptions for orthopedic braces over the phone and the call centers would pass these along to medical equipment companies. These medical equipment companies could then bilk Medicare, sometimes making up $500 - $900 per brace, with kickbacks of $300 to the call centers.



In Conclusion

At Landmark Senior Living, our goal is to create the utmost in independent living for every one of our senior housing residents. Our independent living program is tailored to each individual’s needs and includes robust daily exercise, yoga, & strength training classes available for seniors. Our broad range of activities and events will help you to take care of your mental and physical health.



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