Means testing is the wrong approach to expanding Medicare


The debate over expanding health insurance has thrown a bad idea back into the public arena: means-tested elderly health care benefits. This is something that advocates for the elderly have long opposed, as it would hurt beneficiaries and undermine support for the Medicare program itself. Means-tested benefits should play no role in expanding Medicare to include dental, vision and hearing coverage – which are part of President BidenJoe Biden Majority of Americans Worried About Cyber ​​Attacks on Critical Groups: Poll Secretary of Labor Says 194,000 Jobs Added in September “Not the Best Number” The Biden Task Force has reunited 52 families separated under Trump: PLUS reportThe Build Back Better plan is making its way to Congress.

Such expanded coverage would fill a yawning hole in medicare that has prevented millions of seniors from getting proper care for their eyes, ears and teeth – the gateways to good health. But now some centrist members of Congress want to limit these crucial new coverages to a limited income segment of beneficiaries. It comes down to testing the benefits – something that has been anathema to Medicare since its inception.

The American Dental Associationn (ADA) promoted the idea, fearing dentists would lose money treating Medicare patients with new dental benefits. This is a questionable concern, as dentists would likely benefit from a significantly higher volume of patients, even if health insurance costs are somewhat lower than they are normally paid. Additionally, many dentists already accept private insurance with pre-negotiated fees that are lower than “retail” as this expands their patient base.

Nonetheless, the ADA persists in advocating control over resources. He wants Congress to limit the new dental benefit to seniors with an annual income of about $ 39,000 or less. There is no doubt that the poorest elderly are in dire need of dental coverage. But this means-tested benefit would exclude millions of working-class and middle-class seniors who also cannot afford routine dental care. Seventy percent of Medicare patients who had trouble eating because of their teeth have not been to the dentist in the past year. More than one in ten Medicare beneficiaries said they could not access dental care because of the cost.

The same goes for hearing and vision care. With the average cost of hearing aids over $ 2,500 – and the cost of an eye exam and glasses in the range of $ 250 to $ 500 – a lot of old people just forgo proper care. Neglecting basic dental, vision and hearing care can have adverse health consequences, including high risks of serious and fatal injuries and chronic disease. These health complications are not only bad for the elderly; they can increase Medicare costs in the long run.

Medicare recipients with incomes exceeding $ 39,000 a year should not be excluded from the new benefits because some members of Congress only see numbers on a ledger rather than needy seniors. The majority of the elderly live on a fixed income. Their monthly expenses can increase sharply without notice. (Look at what happened to basic costs like fuel, groceries, and shelter during the pandemic.) Health affairs, one in five of today’s middle class seniors will need expensive long-term care over the next decade. How will they pay for dental, hearing and vision care in addition to these and other expenses related to aging?

When Medicare was created in 1965, President Lyndon B. Johnson strongly opposed means testing because he wanted his signature program to be a universal benefit, not another form of welfare. But if the benefits have never been means tested, the premiums are. (Higher earners pay higher Medicare Parts B and D premiums than lower income earners.) Benefits are equal for everyone on traditional Medicare, regardless of income – a fundamental idea for the success of the program. .

If the average test scores in Medicare become increasingly unfair to higher income beneficiaries, they can opt out and purchase their own policy in the private market. The departure of higher-income beneficiaries, who tend to be younger and healthier, would weaken the risk pool, putting additional strain on Medicare finances. Not to mention that this means that testing new perks could be the “camel nose under the tent” to test all the perks in the future.

Seniors have waited a long time for dental, vision and hearing coverage. Now that Congress is finally ready to expand the program, lawmakers must ensure that new benefits are available for everyone on Medicare. This is how Medicare has worked since its enactment 56 years ago – and how it has become one of the most popular and successful federal programs. In any case, the test of benefits has its place in health insurance.

Max Richtman is Chairman and CEO of the National Committee for the Preservation of Social Security and Medicare in Washington, DC

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