Before the passage of Medicare in 1965, older Americans Americans were one of the least insured populations. Only 56% of older Americans had insurance that covered hospital care. But by 1970, thanks to Medicare, 97% of Americans over the age of 65 were insured. People aged 65 and up have gone from being the most underinsured U.S. population to the most insured.
Still, though Medicare is available to nearly everyone over the age of 65, inequities still show in access to care and gaps in coverage. They mostly impact low-income populations, especially African Americans and Latinx people. Often, these groups overlap.
Medicare is based on the concept of “universal care.” This means:
- It seeks to fill the gap created by private insurance, where insurance is linked to employment and employers decide what kind of coverage you receive and how long you get it. Medicare makes sure you won’t lose your coverage as you get older, retire, if you get sick, or if you lose your spouse.
- Medicare offers basic hospital and doctor care to all Americans aged 65 and up.
- Your choices of providers are very broad. Almost all providers participate in Medicare, so you get to choose from the same doctors and hospitals as anyone else.
- Medicare provides financial relief to high health care costs, even though you might pay a premium.
Chronic Disease and Functional Issues
For most people who have worked at least 10 years and paid into Social Security, Part A of Medicare -- which primarily covers hospital care -- is free. Part B, which provides coverage for outpatient care, such as doctor’s visits, requires people to pay a monthly premium. In addition, Medicare has deductibles and co-insurance that enrollees must pay when they receive care. There is financial help for low-income enrollees to pay their Part B premiums and cost-sharing, but for most enrollees Medicare costs can be significant.
Older people also may need help with functional services, such as basic tasks like getting dressed, eating, and using the bathroom. Medicare provides some home health care as long as it is expected to improve the person's condition-- for example, speech therapy after a stroke. Medicare does not provide ongoing help with activities of daily living, such as bathing or feeding. Medicare also does not cover long term care either in-home or in a nursing home.
People of Color and Access to Care
Medicare has improved the insurance status of seniors of all races. Medicare patients are not immune to the racial disparities that exist in accessing medical care, however, including:
- Members of racial and ethnic marginalized communities are more likely to live in poverty and have more illnesses. They report more cases of dementia and other cognitive issues, and tend to need more functional assistance than white people.
- These needs create a greater financial burden, which further limits their access to care.
- Both African American and Latinx people, who together make up more than half of minorities who receive Medicare, are more likely to have serious health issues – and thus need more long-term care.
- Lack of retiree health benefits to supplement Medicare coverage and reduce out-of-pocket costs.
Other factors specific to minorities include:
- Language barriers increase the chances of misdiagnosis and can make it hard to understand medication and discharge instructions.
- Minorities are more likely to live in areas that don’t have enough access to fresh, healthy food. Thus, they’re more likely to have chronic diseases like diabetes. New programs seek to increase access to fruits and vegetables that can lower these numbers.
These gaps will grow much wider in coming years as people of color make up a larger percentage of the U.S. population. For example, By 2025, the African American and Latinx elderly population is projected to soar to 35% of the total, a much larger percentage than for whites.
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Health Care Financing Review: “What Medicare Has Meant To Older Americans,” “Medicare, Medicaid, and the Elderly Poor.”
Centers for Medicare & Medicaid Services: "Original Medicare (Part A and B) Eligibility and Enrollment."
Medicare.gov: "Home health services."
Center for Medicare Advocacy: “Racial and Ethnic Health Care Disparities.”
Kaiser Family Foundation: “The Faces of Medicare: Medicare and Minority Americans.”
The Commonwealth Fund: “As It Grows, Medicare Advantage Is Enrolling More Low-Income and Medically Complex Beneficiaries.”
Health Affairs: “Medicare’s Current And Future Role In Reducing Racial And Ethnic Health Disparities.”
National Committee to Preserve Social Security & Medicare: “African Americans and Medicare.”
Medicareresources.org: “Medicare Advantage (Part C) Private Health Plans.”