When most people think of health care coverage for seniors, Medicare comes to mind. But thanks to the Affordable Care Act, Medicaid has grown to play a pivotal role in how our aging population pays for health care services. Under the ACA’s Medicaid expansion provision, eligibility is expanded to those with annual incomes of up to 138% of the federal poverty level ($16,394 for an individual in 2016). As a result, quality health care coverage is afforded to more low-income, uninsured Americans — including seniors.
Why is this expansion important to seniors?
Medicaid now covers more than 4.6 million low-income seniors, nearly all of whom are also covered by Medicare. This is important because poverty and old age are closely linked. Although most seniors are covered by Medicare, the program has lofty out-of-pocket costs that can strain a fixed budget. Having dual Medicare and Medicaid coverage improves access to care for beneficiaries, encompassing a range of benefits and minimizing self-pay obligations. According to the National Committee to Preserve Social Security & Medicare, Medicare beneficiaries will save an average of $5,000 over the next 10 years as a result of health care reform.
What’s more, commercial insurance doesn’t always cover the spectrum of health care services seniors need to enjoy autonomy and a good quality of life. Long-term services and supports — which assist older individuals with routine daily tasks such as bathing, dressing, and preparing meals — are a prime example. These kinds of services are vital to seniors who are managing chronic health problems or suffering age-related physical or cognitive decline.
In essence, Medicaid fills gaps left by Medicare — gaps that affect low-income beneficiaries. With fuller access to health care services, seniors are able to remain in their communities longer, which is beneficial to both them and their state. And when an older adult has to shoulder fewer out-of-pocket costs, they have more money to spend on basic necessities.
What happens in states that don’t expand Medicaid coverage?
While it’s true the ACA was upheld by the Supreme Court in 2012, states were given the ability to opt out of the Medicaid expansion. To date, 32 states have adopted it, while 19 have not. In states choosing to opt out of the Medicaid expansion, Medicaid eligibility for adults is limited. Nearly 3 million poor, uninsured adults fall into a coverage gap where they have incomes in excess of eligibility limits, but below the lower threshold for marketplace premium tax credits. When they do require care, older adults in this gap may be burdened with high medical bills. Lack of coverage may cause them to delay seeking care until health problems become dire.
If opt-out states do adopt the Medicaid expansion, all of the nearly 3 million adults in the coverage gap would become eligible. Furthermore, 1.8 million adults who are eligible for Marketplace coverage would also become Medicaid-eligible, giving them access to lower health insurance premiums and cost-sharing opportunities.
What if the Medicaid expansion is repealed?
Some politicians — concerned about the ACA’s long-term impact on programs such as Medicaid and Social Security — have proposed partially or fully repealing Medicaid expansion. If this happens, most of the people who have joined the Medicaid rolls since 2013 would lose coverage (at least 14 million people, including nearly 5 million seniors). State Medicaid programs would hemorrhage $900 billion over 10 years.
Without the ACA’s Medicaid expansion, the health and well-being of millions of low-income seniors are at risk. Public health can do their part by helping lawmakers grasp the significance of Medicaid expansion for seniors as well as others who would be newly eligible. Safeguarding this ACA provision from federal and state budget cuts is paramount to keeping health care coverage accessible to our nation’s most vulnerable populations.