Seniors with Complex Health Care Needs Deserve to Know Their Choices

Posted by: Allyson Schwartz

Imagine being so burdened by health care costs that you were forced to empty your life savings or started receiving calls from debt collectors.

This is not some hypothetical scenario from ages past, it is the painful experience for 36 percent and 27 percent, respectively, of seriously ill Traditional Medicare beneficiaries today, according to new research from Harvard University and the Commonwealth Fund.

When President Lyndon B. Johnson signed Medicare into law in 1965, he inspired Americans with a promise that “No longer will illness crush and destroy the savings that they [seniors] have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”

Yet, given this report’s findings that Traditional Medicare beneficiaries over the age of 85 spend an average of $10,307 annually on out of pocket costs and 23 percent of the sickest enrollees are unable to pay for basic necessities, it is clear this decades-long promise is threatened.

Medicare’s Traditional fee-for-service model is simply not living up to the vision that President Johnson and Congress made to protect older Americans’ health and financial security. This legacy and, most importantly, today’s seniors deserve better.

For us – as a former lawmaker who fought to expand affordable health coverage and a physician of more than 30 years working to address health disparities in the Hispanic community – it also highlights the importance of empowering Medicare enrollees to know their options.

For many beneficiaries, Medicare Advantage – which offers extra benefits and important cost protections, including an annual limit on out-of-pocket expenses unavailable in Traditional Medicare, could be the right choice.

Consider that half of Medicare Advantage enrollees are in $0 premium plans, whereas the average Traditional Medicare enrollee spends a whopping $2,294 on premiums alone each year.

What’s more, 58 percent of Medicare Advantage plans provide dental, vision, hearing and fitness benefits – none of which are covered under Traditional Medicare – meaning enrollees are getting more coverage at a lower cost.

In addition, there is increasing evidence that care coordination and case management available in Medicare Advantage achieves better outcomes for beneficiaries with multiple chronic conditions; complex patients who are able to receive care in the home, transportation, or meal delivery to improve their health and well-being

The problem? As many as 45 percent of seniors are unaware they have a choice in how they receive their Medicare coverage.

That means Medicare eligible beneficiaries on fixed incomes with serious health care needs are defaulting into a program that places no limit on their out-of-pocket expenses and leaves them to shoulder too much of the cost burden, not knowing that there is another way. This is flat wrong.

Better Medicare Alliance has been working to ensure that information about Medicare Advantage is clear, complete, and understandable to seniors. We’ve already seen success.

For example, the 2020 “Medicare & You” handbook includes upfront, easy-to-read information about the choice between Traditional Medicare and Medicare Advantage right on page six, instead of pages later in the more-than-100 page booklet.

When beneficiaries find their way to Medicare Advantage, they like what they find. It’s no surprise then, that Medicare Advantage enrollment has grown significantly in recent years and is projected to reach 40 percent of the people eligible for Medicare, a record of 24.4 million people, next year. The Hispanic community plays an outsized role in this trend with 57 percent of Hispanic Medicare eligible beneficiaries choosing Medicare Advantage.

One reason is that Medicare Advantage beneficiaries report an average of $1,276 less in total health care spending each year than their Traditional Medicare counterparts. Consider what this savings could mean to the widower with diabetes, the retiree battling cancer, the grandmother facing dementia, or the elderly neighbor recovering from a stroke.

For millions of our nation’s seniors facing such challenges, it is Medicare Advantage that is best honoring Medicare’s original solemn pledge to protect their health and personal finances.

As Medicare’s annual open enrollment season heads into its last few weeks, Washington must ensure that today’s beneficiaries – and those yet to come – know the value of each of their choices.

Allyson Y. Schwartz is the president and CEO of the Better Medicare Alliance. She represented Pennsylvania in the House as a Democrat from 2005 to 2015.

Elena Rios, MD, MSPH is the president and CEO of the National Hispanic Medical Association.