Medicare Beneficiaries and High Out-of-Pocket Medical Expenses

A recent analysis of the Medicare Current Beneficiary Survey reveals a great deal of information about the current out-of-pocket expenses of Medicare beneficiaries, as well as possible scenarios that might arise in the event of healthcare reform. Although 56 million people, or 17 percent of the American population, rely on Medicare for their healthcare needs, Medicare does not provide coverage for some types of medical expenses, such as expenses related to dental care, vision loss, hearing loss, and long-term care; these expenses remain the sole responsibility of the individual in need. There also is no ceiling on the amount of out-of-pocket medical expenses that a Medicare beneficiary must pay.

The survey data indicates that the typical Medicare beneficiary spends over $3,000 per year in out-of-pocket medical costs. For 15 million of these people, or more than one quarter of all Medicare beneficiaries, the amount that they must pay in total out-of-pocket expenses comes to 20 percent or more of their annual incomes spent on uncovered medical expenses, despite Medicare coverage. These figures present a significant financial risk to those individuals whose incomes fall below 200% of the poverty level, or just under $24,000 for a single person.

This analysis points out that despite the reliance of millions of people on Medicare for health care needs, substantial gaps still exist between the expenses that Medicare covers and those that it does not. Individuals can get prescription drug coverage, but only by purchasing a separate private plan. Individuals also can get coverage to supplement their Medicare coverage, but in order to do so, they must purchase private Medigap supplemental coverage. Nonetheless, many healthcare expenses remain uncovered, even after the individual purchases additional coverage.

The results of this analysis underscore the need for caution in proposing changes to Medicare, as these changes will almost certainly occur in the near future. By 2024, the impact of any Medicare changes will be even more widespread; statistics indicate that by 2024, Medicare will cover 1/5 of the population. As the American population ages, the need for supplemental coverage will continue to grow, at the expense of Medicare recipients.

Whether your loved one has Medicare coverage or not, out-of-pocket medical expenses are likely to be a problem. Those expenses can become even more overwhelming once your loved one enters a long-term care facility, such as a nursing home or a community based residential facility. Not only might you worry about these expenses, but you might worry about the care that your loved one is receiving. If you or a loved one is in this situation, you should definitely contact an experienced Wisconsin elder law attorney at Boller & Vaughan. We know how to protect your rights and ensure that you are taking advantage of all resources that are available to protect you. Contact Boller & Vaughan today and see what assistance we can offer you and your family.