Elderly Americans: Insurance Priorities

The most common insurance carried by elderly Americans is Medicare, a federal health insurance program for people aged 65 or older, as well as certain people with disabilities and those with end-stage renal disease. In 2019, approximately 59 million people over the age of 65 were covered by Medicare, which offers near-universal coverage for the elderly—in 2022, only 457,000 people, or less than 1% of those over 65, were uninsured.

Medicare was created in 1965 to improve access to acute health care services for the elderly. It covers inpatient and outpatient hospital care, physician care, medical equipment and supplies, as well as some skilled nursing care, home health services, and hospice care.

In addition to Medicare, elderly Americans may also have supplemental private insurance, such as employer-sponsored retirement insurance or individually purchased medigap insurance policies. In 1991, about three-fourths of those on Medicare had some form of private insurance.

Medicare: the federal health insurance program for over-65s, certain people with disabilities, and those with end-stage renal disease

Medicare is a federal health insurance program for Americans aged 65 and over. It was established in 1965 and has covered people under 65 with disabilities since 1973.

Medicare has two parts: Part A, which is hospital insurance, and Part B, which is medical insurance. Most people do not have to pay for Part A, but most people pay monthly for Part B.

To qualify for Medicare under the age of 65, people must receive Social Security Disability Insurance (SSDI) benefits. This means they must be unable to engage in "substantial gainful activity" because of a physical or mental impairment that is expected to last at least 12 months or until death. People under 65 who are diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) automatically qualify for Medicare upon diagnosis without a waiting period.

Medicare covers certain widows and widowers under 65 with disabilities, as well as disabled adult children of retired, deceased, or disabled workers. In 2012, nearly one-quarter of younger beneficiaries with disabilities had incomes of less than $10,000 per year, and two-thirds had incomes of less than $20,000 per year.

Medicare beneficiaries under 65 with disabilities differ demographically, socioeconomically, and in health status from beneficiaries aged 65 or older. A larger share of younger beneficiaries are black or Hispanic, male, and have cognitive or mental impairments. They are also more likely to report themselves as being in poor health and have limitations in daily activities.

Medicare coverage is the same for people who qualify based on disability as for those who qualify based on age. Coverage includes certain hospital, nursing home, home health, physician, and community-based services. The healthcare services do not have to be related to the individual's disability to be covered.

Medicare eligibility for working people with disabilities falls into three time frames: the trial work period, which lasts for nine months after a disabled individual obtains a job; the seven-and-three-quarter years (93 months) after the trial work period; and an indefinite period following those 93 months.

Even after the eight-and-one-half years of extended Medicare coverage has ended, working individuals with disabilities can continue to receive benefits as long as they remain medically disabled and pay the premium for Part A and Part B.

Medicaid: a federal-state program providing free/low-cost health coverage to low-income families, children, pregnant women, the elderly, and people with disabilities

Medicaid is a federal-state program that provides free or low-cost health coverage to people with low incomes, including families, children, pregnant women, the elderly, and people with disabilities. In 2017, 19.3% of the population was covered by Medicaid, making it the second most common form of health insurance coverage in the US.

Medicaid provides health coverage to 7.2 million low-income seniors who are also enrolled in Medicare, accounting for more than 15% of all Medicaid enrollees. It also covers additional services beyond those provided by Medicare, including nursing facility care beyond the 100-day limit, prescription drugs, eyeglasses, and hearing aids.

The Program of All-Inclusive Care for the Elderly (PACE) is a program under Medicaid that provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits. PACE enables participants to receive coordinated care from an interdisciplinary team of health professionals and helps them remain in the community rather than receive care in a nursing home.

Medicaid's long-term services also enable eligible individuals to live in the setting most appropriate for their needs, whether that is a nursing facility, their own home, or a caregiver's home.

Employer-based insurance: in 2019, 159 million non-institutionalized persons under 65 obtained coverage from their employer

Employer-sponsored health insurance is a crucial component of the healthcare landscape in the United States, offering financial protection and healthcare access to millions. In 2019, 159 million non-institutionalized persons under 65 benefited from employer-based insurance, highlighting its significance in the country's healthcare system. This type of insurance is typically offered by employers as part of a comprehensive benefits package, and it plays a vital role in reducing the financial burden of medical expenses for employees.

The impact of employer-sponsored health insurance is far-reaching. Firstly, it provides employees with peace of mind, ensuring they can seek necessary medical care without facing exorbitant costs. This not only helps maintain their health and well-being but also reduces long-term healthcare costs. Additionally, from an employer's perspective, offering health insurance can attract and retain top talent, boost employee morale and productivity, and even provide certain tax incentives.

The number of people covered by employer-based insurance has remained relatively stable over time, even as the non-elderly population grew by 34.2 million between 1998 and 2018. However, it's important to note that the share of the non-elderly population with employer-sponsored health insurance decreased during this period, dropping by more than 8 percentage points. This decline is particularly notable among lower and moderate-income households, where employer-based coverage is becoming less common.

Despite these changes, employer-sponsored health insurance remains a significant source of coverage for non-elderly individuals. In 2023, it was estimated that nearly 153 million non-elderly people relied on this type of insurance. On average, employees contribute about 17% of the premium for single coverage and 29% for family coverage, with employers subsidizing the remaining costs.

The specific type of employer-sponsored health insurance offered can vary. Preferred Provider Organization (PPO) plans are the most common, followed by High Deductible Health Plans with Savings Options (HDHP/SO). Health Maintenance Organization (HMO) plans and Point-of-Service (POS) plans are also offered, but to a lesser extent.

Company size and industry play a crucial role in determining the coverage available in employer-sponsored health insurance plans. Larger companies often have more negotiating power to secure comprehensive coverage with lower premiums, while smaller companies may offer more basic plans with higher out-of-pocket costs for employees.

In conclusion, employer-based insurance is a vital component of the US healthcare system, particularly for those under 65. While it offers numerous benefits to both employees and employers, it is important to continuously evaluate its effectiveness, especially for low and moderate-income individuals, to ensure that healthcare remains accessible and affordable for all.

Non-employer-based insurance: in 2019, 84 million non-institutionalized persons under 65 obtained coverage from non-employer sources

In 2019, 84 million non-institutionalized persons under 65 obtained non-employer-based insurance. This means that they were covered by sources other than their workplace, such as Medicaid, the Children's Health Insurance Program (CHIP), the Affordable Care Act (ACA) Medicaid expansion, the ACA/Obamacare exchanges, or private insurance purchased outside the ACA exchanges.

The number of people with non-employer-based insurance is significant, but it's worth noting that even more people in this age group (159 million) obtained employer-based coverage. Additionally, 30 million people under 65 were uninsured in 2019.

The overall US population in 2019 was approximately 330 million, with 59 million people aged 65 and over covered by Medicare.

The high cost of health insurance in the US is a significant concern for many Americans, and it is the primary reason given for problems accessing healthcare. As of 2019, the US was the only industrialized nation without universal healthcare coverage.

Military coverage: in 2018, 12 million military personnel received coverage through the Veteran's Administration

Military coverage is one of the subtypes of health insurance coverage in the United States. In 2017, 4.8% of people in the US had military coverage, which equates to around 12 million people.

Military coverage is provided by the Veterans Affairs (VA) health care program. VA health care is available to all veterans and covers regular checkups with a primary care provider, as well as appointments with specialists such as cardiologists, gynecologists, and mental health providers. VA health care also covers home health and geriatric (elder) care, and provides medical equipment, prosthetics, and prescriptions.

VA health care is tailored to each veteran's needs. It covers treatment for illnesses and injuries, as well as preventive care to stop future health problems. It can also help improve veterans' ability to function and enhance their quality of life.

In addition to health care, VA benefits can also include assisted living, residential, or home health care, as well as non-medical services such as beneficiary travel benefits and caregiver support.

VA health care is integrated with other forms of health care coverage, such as private insurance plans, Medicare, and Medicaid.

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