American Lives
Medicare Successes and Challenges
For 38 years, the Medicare program has been a lifeline for older adults and people with disabilities. It has increased access to health care and reduced financial burdens for countless numbers of people and their families.
Because Medicare’s benefit package has not kept pace with advances in modern medicine, public discourse has focused on its gaps rather than its fundamental accomplishments. Critics of Medicare have pointed to its gaps to justify major restructuring of the program that could undermine its strengths. In contrast, Medicare’s supporters have argued that the program works well and that additional benefits should be incorporated into its current structure.
The Medicare Rights Center believes the single-payer structure of the Medicare program works best for older and disabled Americans. In fact, it was the failure of the private marketplace to care for these particularly vulnerable populations that led to the inception of the Medicare program (see History of Medicare & the Current Debate).
Medicare, however, needs to cover prescription drugs and long-term care.
To illustrate Medicare's successes and its challenges, MRC has launched American Lives, collecting the stories of people with Medicare who are experiencing barriers to care.
Mrs. Powers suffers from diabetes, high cholesterol, anemia and a thyroid condition, requiring ten prescription drugs a day. She has no prescription drug coverage and her state doesn't offer any drug assistance program. She has been forced to skip doses, split pills and sometimes forego her life-saving prescriptions altogether.
Mr. Graves has very little money and goes to soup kitchens and senior centers for his meals and general assistance. Mr. Graves applied for assistance paying for his Medicare premiums and coinsurance through a Medicare Savings Program and received a “Notice of Action” stating that he was eligible for the help through the Qualified Medicare Beneficiary (QMB) program, but after waiting nearly a year and a half he still has not received his QMB benefits.
Mr. Franks is 56 years old and has multiple sclerosis. He is confined to a wheelchair and needs help feeding himself, but his certified home health agency is terminating his Medicare-covered home care because it has determined that he no longer requires “skilled care.” Mr. Franks cannot afford to pay for the care himself, but does not qualify for Medicaid because of the small income he gets from renting the second floor of his house.
Mrs. O’Connor is 72 years old and suffers from a chronic psychiatric disability. Her psychiatrist has advised her to seek ongoing therapy treatment, but Mrs. O’Connor has had to stop her sessions because her mental health coverage is inadequate and her out-of-pocket costs are too high.