Healthcare Insurance: Public and Private
Medicare and Medicaid are the government’s two major healthcare financing programs. Medicare is America’s answer to healthcare financing for the elderly and disabled, and Medicaid was developed to pay for healthcare services for the poor and disabled. Most people are not enrolled in Medicare or Medicaid but private insurers often take their cues from what Medicare does and does not cover, so the Medicare rules have relevance for all of us. So do the Medicaid rules, because those of us who have a loved one in need of nursing home care usually have to decide whether or not to apply for Medicaid, a decision that has significant financial consequences.
Medicare
Medicare was instituted with fanfare in the 1960s and rightly so. It was the first federal program designed to pay for hospital care and doctors’ visits for our senior population. At
the time, most seniors were in their sixties and needed treatment for immediate, acute-care problems for a short duration, conditions such as a broken hip or pneumonia. But as
we’ve seen, a great deal has happened since then. A great many of the folks who were in their mid-fifties and mid-sixties when the program began are in their eighties and nineties today. They are suffering from chronic conditions, such as Alzheimer’s disease and other dementias, hypertension, diabetes, emphysema, long-term cancers, and the aftermath of a stroke, which they were much less likely to survive in the 1960s.
In fact today, more than 300 million people in America are living with at least one chronic condition. The kind of care today’s old and oldest-old seniors need is more extensive than the care they needed forty years ago. It is more long term, and much of it isn’t quite medical, although it is necessitated by medical conditions or the frailties that come with old age. Some need help maintaining a household including shopping, paying bills, and housekeeping. Others can’t manage these tasks and also are unable to take care of their personal-care needs, such as dressing, toileting, bathing, and other activities of daily living. Between age sixty-five and sixty-nine, only 9 percent of the population requires such help, but within the eighty-five and older population, 50 percent of individuals need such assistance.
