Congressional Democrats and the Biden administration are looking to expand Medicare
Senate Democrats are crafting a $3.5 trillion budget proposal that could add dental, vision, and hearing coverage to Medicare or lower the eligibility age
Broader proposals, such as âMedicare for Allâ or a public option, may be on the backburner
Medicare Covers Different Services Under Several Parts
| PARTS | COVERAGE | BENEFICIARY COSTS | FINANCING |
|---|---|---|---|
| Part A: Hospital Insurance | Inpatient hospital, SNFs, hospice, some home health, Coverage | Premium-free for most; out-of-pocket costs vary, no annual catastrophic cap on out-of-pocket costs | Payroll tax revenue, goes into Hospital Insurance Trust fund |
| Part B: Medical Insurance | Physician services, outpatient hospital, equipment, drugs furnished by physicians, some home health & preventive services | Premiums vary by income; deductible $203 in 2021, 20% coinsurance, no annual catastrophic cap | Beneficiary premiums, general revenue into Supplementary Medical Insurance Trust Fund |
| Part C: Medicare Advantage | Private plans similar to Part A & B, may include additional benefit options or drug coverage | Premiums and out-of-pocket costs vary by plan; catastrophic cap and generally smaller out-of-pocket costs than Part A or B | Funded through both trust funds |
| Part D: Prescription drugs | Outpatient prescriptions drugs through private plans | Income-based premiums; standard coverage includes 25% coinsurance, 5% above catastrophic limit | Premiums, revenue go into separate SMI fund account |
Medicare Covers Roughly 63 Million People
Serves adults 65 and older and those of any age who receive disability benefits
-Parts A and B are considered âoriginalâ or âtraditionalâ Medicare; government pays for services directly
-About 60% of beneficiaries are enrolled in Parts A & B
-40% in Medicare Advantage
-Medicare Advantage and Part D are optional; government pays private insurers to provide benefits
88% of beneficiaries had additional coverage in 2016 to cover other services, help offset costs
-Eyeglasses, contact lenses, hearing aids, dentures, arenât included in traditional Medicare coverageâthough Medicare Advantage plans may offer these services at additional cost
-Most long-term care services arenât covered
-Medigap policies cover Medicareâs out-of-pocket costs
-Some beneficiaries may qualify for Medicaid or have access to employer-based coverage
Democrats Eyeing Medicare Expansion
Progressives want to expand benefits, lower eligibility age in budget reconciliation
-Proposal to add vision, dental, and hearing benefits to Part B could cost $358 billion over a decade, according to CBO estimate of a previous proposal (H.R. 3 in the 116th Congress)
-Lowering eligibility age to 60 could cost $200 billion, according to document on Senate Budget Chairman Bernie Sandersâ (I-Vt.) budget plan
Centrist Democrats pushing for other health-care policies
-Some moderate Democrats prefer encouraging states to expand their Medicaid programs and making Affordable Care Act subsidies permanent
-House Budget Chair John Yarmuth (D-Ky.) said lowering eligibility age âhas about 75% support in the caucusâ
Medicare Costs Projected to Reach Nearly $1.5T by 2031
Bills Offer Variety of Approaches to Medicare, Health Coverage
Presidentâs budget proposal indicated support for Medicare proposals but didnât including funding for them
-Said access to dental, vision, and hearing through Medicare should be improved
-Supports option to enroll in Medicare at 60, with financing outside the Medicare trust fund
Democrats reintroduced âMedicare for All,â public option, and buy-in plans
-Rep. Pramila Jayapal (D-Wash.) introduced the âMedicare for All Actâ (H.R. 1976) to create a single-payer system that offers universal coverage and no cost-sharing
-Several bills, including âMedicare-X Choice Actâ (S. 386, H.R. 1227), would create a public insurance option that individuals could purchase through the ACA health exchanges
-Other measures (S. 1279, H.R. 2881) would allow those ages 50 to 64 to purchase Medicare with separate premiums and financing
Medicare is Third-Largest Source of Health Coverage
Budget Reconciliation Is Key Path Forward for Democrats
Democrats eyeing $3.5 trillion reconciliation bill without support from Republicans
-Senate crafting a budget resolution that would set up reconciliation process
Aim to adopt resolution before August recess; unclear when House would take up measure
Reconciliation bill with proposals from several committees will likely come later in the year
Only a simple majority needed for passage of measure, though provisions must comply with budget rules
-Leaders must chart a path between progressive proposals and moderates in closely divided chambers
Lawmakers have floated Medicare drug price negotiations as a way to offset some of the costs of proposals to expand benefits and coverage
Republicans oppose expanding Medicare, point to trust fundâs approaching insolvency
-Lowering Medicare eligibility âwould likely crowd out private coverage without moving the needle on access or affordability,â Finance Committee ranking member Mike Crapo (R-Idaho) wrote June 10
-âMedicare is five short years from going effectively broke,â and Bidenâs budget proposal didnât address the problem, wrote Ways and Means ranking member Kevin Brady (R-Texas) in a June 8 letter
Medicare Expansion Proposals
Bloomberg
August 5, 2021 9:56 am
Congressional Democrats and the Biden administration are looking to expand Medicare
Senate Democrats are crafting a $3.5 trillion budget proposal that could add dental, vision, and hearing coverage to Medicare or lower the eligibility age
Broader proposals, such as âMedicare for Allâ or a public option, may be on the backburner
Medicare Covers Different Services Under Several Parts
| PARTS | COVERAGE | BENEFICIARY COSTS | FINANCING |
|---|---|---|---|
| Part A: Hospital Insurance | Inpatient hospital, SNFs, hospice, some home health, Coverage | Premium-free for most; out-of-pocket costs vary, no annual catastrophic cap on out-of-pocket costs | Payroll tax revenue, goes into Hospital Insurance Trust fund |
| Part B: Medical Insurance | Physician services, outpatient hospital, equipment, drugs furnished by physicians, some home health & preventive services | Premiums vary by income; deductible $203 in 2021, 20% coinsurance, no annual catastrophic cap | Beneficiary premiums, general revenue into Supplementary Medical Insurance Trust Fund |
| Part C: Medicare Advantage | Private plans similar to Part A & B, may include additional benefit options or drug coverage | Premiums and out-of-pocket costs vary by plan; catastrophic cap and generally smaller out-of-pocket costs than Part A or B | Funded through both trust funds |
| Part D: Prescription drugs | Outpatient prescriptions drugs through private plans | Income-based premiums; standard coverage includes 25% coinsurance, 5% above catastrophic limit | Premiums, revenue go into separate SMI fund account |
Medicare Covers Roughly 63 Million People
Serves adults 65 and older and those of any age who receive disability benefits
-Parts A and B are considered âoriginalâ or âtraditionalâ Medicare; government pays for services directly
-About 60% of beneficiaries are enrolled in Parts A & B
-40% in Medicare Advantage
-Medicare Advantage and Part D are optional; government pays private insurers to provide benefits
88% of beneficiaries had additional coverage in 2016 to cover other services, help offset costs
-Eyeglasses, contact lenses, hearing aids, dentures, arenât included in traditional Medicare coverageâthough Medicare Advantage plans may offer these services at additional cost
-Most long-term care services arenât covered
-Medigap policies cover Medicareâs out-of-pocket costs
-Some beneficiaries may qualify for Medicaid or have access to employer-based coverage
Democrats Eyeing Medicare Expansion
Progressives want to expand benefits, lower eligibility age in budget reconciliation
-Proposal to add vision, dental, and hearing benefits to Part B could cost $358 billion over a decade, according to CBO estimate of a previous proposal (H.R. 3 in the 116th Congress)
-Lowering eligibility age to 60 could cost $200 billion, according to document on Senate Budget Chairman Bernie Sandersâ (I-Vt.) budget plan
Centrist Democrats pushing for other health-care policies
-Some moderate Democrats prefer encouraging states to expand their Medicaid programs and making Affordable Care Act subsidies permanent
-House Budget Chair John Yarmuth (D-Ky.) said lowering eligibility age âhas about 75% support in the caucusâ
Medicare Costs Projected to Reach Nearly $1.5T by 2031
Bills Offer Variety of Approaches to Medicare, Health Coverage
Presidentâs budget proposal indicated support for Medicare proposals but didnât including funding for them
-Said access to dental, vision, and hearing through Medicare should be improved
-Supports option to enroll in Medicare at 60, with financing outside the Medicare trust fund
Democrats reintroduced âMedicare for All,â public option, and buy-in plans
-Rep. Pramila Jayapal (D-Wash.) introduced the âMedicare for All Actâ (H.R. 1976) to create a single-payer system that offers universal coverage and no cost-sharing
-Several bills, including âMedicare-X Choice Actâ (S. 386, H.R. 1227), would create a public insurance option that individuals could purchase through the ACA health exchanges
-Other measures (S. 1279, H.R. 2881) would allow those ages 50 to 64 to purchase Medicare with separate premiums and financing
Medicare is Third-Largest Source of Health Coverage
Budget Reconciliation Is Key Path Forward for Democrats
Democrats eyeing $3.5 trillion reconciliation bill without support from Republicans
-Senate crafting a budget resolution that would set up reconciliation process
Aim to adopt resolution before August recess; unclear when House would take up measure
Reconciliation bill with proposals from several committees will likely come later in the year
Only a simple majority needed for passage of measure, though provisions must comply with budget rules
-Leaders must chart a path between progressive proposals and moderates in closely divided chambers
Lawmakers have floated Medicare drug price negotiations as a way to offset some of the costs of proposals to expand benefits and coverage
Republicans oppose expanding Medicare, point to trust fundâs approaching insolvency
-Lowering Medicare eligibility âwould likely crowd out private coverage without moving the needle on access or affordability,â Finance Committee ranking member Mike Crapo (R-Idaho) wrote June 10
-âMedicare is five short years from going effectively broke,â and Bidenâs budget proposal didnât address the problem, wrote Ways and Means ranking member Kevin Brady (R-Texas) in a June 8 letter