Medicare or Medicaid?  Got Coverage?

Submitted by Cassie Deacon, MSW Candidate

Medicare vs. Medicaid

As highlighted in January’s blog, the older adult population in the U.S is projected to grow to 45.8 billion individuals by 2050.  But who will insure this growing number of older adults?  In 2015, over 14% of California’s population were Medicare beneficiaries and over 58% of the state’s population were enrolled in Medicaid (Medi-Cal here in California) coverage under the Affordable Care Act (CDC, 2015).

The uncertainty of the future of the Affordable Care Act and funding for Medicare and Medicaid, older adults and caregivers are often left wondering what basic and crucial healthcare services are available and how to enroll and access these programs.

Enrollment and eligibility information for Medicare can be found at here.

Enrollment and eligibility information for Medicare (Medi-Cal) can be found here.

Community members can also receive additional guidance and resources by calling 2-1-1 or visiting 2-1-1 San Diego’s website. Counselors are available 24/7 to help walk individuals through community resources, eligibility criteria and application processes for both Medicare and Medi-Cal.

 
 
 
 
 
 
 
 
 

Services covered in California:

Medicare:

Medicare

Medi-Cal:

Medi-Cal

Resources shared from Alzheimer’s San Diego:  Medi-Cal Information Sheet

For full list of benefits for each program please visit.

While millions of older adults depend on Medicare and Medicaid for health coverage, gaps in services still exist leaving individuals uninsured and lacking necessary care.  Assisted living and Residential Care Facilities for the Elderly (RCFEs) remain exorbitantly expensive and with minimal reimbursement from Medicare or Medicaid, the financial burden of these costs falls to the patients and families.  Further, there is a lack of standardization of appropriate assessment tools to assess eligibility criteria, funding for continuity of care is lacking and agencies are understaffed to meet the current and future demands for services.  While gaps between Medicare and Medi-Cal programs can be addressed by dual eligibility, the cumbersome application process and eligibility criteria often discount many at-need individuals.

With an unstable political climate surrounding the Affordable Care Act, it is still unclear how the next four years will impact both Medicare and Medi-Cal funding and older American’s access to health insurance.  But California is leading the way in having conversations about alternatives and such as the proposed bill SB 562: The Healthy California Act, a universal single-payer health care coverage plan. The Healthy California Act, passed the vote in the Senate and is up for vote in the Assembly, opening eligible enrollment for all California residents.  Expansions upon Medi-Cal include offering a broad benefit program with all programs currently covered by Medi-Cal and Medicare, in addition to allowing choice of service provider from participating identified physicians and clinicians.  The Healthy California Act also seeks create a Center for Medicare and Medicaid Services Innovation, to test and assess payment and service delivery models to reduce program expenditures under the Medicare and Medicaid, while preserving the quality of care accessible to individuals.

The future of Medicare and Medi-Cal programs are uncertain, but through honest and direct conversations about the needs of constituents and speaking out for advocacy to ensure accessible health care for all, a new approach for health care can and must be developed.

Resources:

Adams, L. (2016, September 20). What Changes in Medicare Can You Expect for 2017? Retrieved May 30, 2017, from http://www.huffingtonpost.com/laura-adams/what-changes-in-medicare-_b_12049482.html

Aging, C. D. (n.d.). Recent State Legislation. Retrieved June 06, 2017, from https://www.aging.ca.gov/Resources/Recent_State_Legislation/

Facing Death. (n.d.). Retrieved May 30, 2017, from http://www.pbs.org/wgbh/pages/frontline/facing-death/facts-and-figures/

Medicare vs. Medicaid [INFOGRAPHIC]. (2016, October 26). Retrieved June 06, 2017, from https://www.healthmarkets.com/resources/medicare/medicare-vs-medicaid-infographic/I

Providing Care & Support for San Diego. (n.d.). Retrieved May 30, 2017, from http://www.alzsd.org/

The Healthy California Act, S. 562 (2017).

Total Monthly Medicaid and CHIP Enrollment. (2017, May 18). Retrieved May 30, 2017, from http://www.kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22%3A%22Location%22%2C%22sort%22%3A%22asc%22%7D#