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What Does Medicare for All Mean?


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“Medicare for all” is an idea being promoted, among others, by Vermont senator Bernie Sanders and California senator Kamala Harris, presidential candidates in the 2020 election.

Currently, Medicare is a government-sponsored health insurance program for those aged 65 and over, and those under age 65 who qualify by disability. You need to be an American citizen or permanent resident of 5 years or more.

But some people want Medicare to cover all Americans, not just those who qualify today. A general term for this is “Medicare for all.” But exactly what people mean by Medicare for all depends on who you ask.

Some legislators are trying to get bills passed that would make Medicare available for more people.

Medicare for all: multiple proposals                                                                                                                                                                                                                                                                                                                                      

Legislators have drawn up several proposals. They range from extending Medicare to eligible people of all ages, to expanding Medicare somewhat less broadly, to new public health plan options, to other health insurance solutions. Here are summaries of the proposed programs reported by Kaiser Family Foundation (KFF).

Medicare for all: two prominent proposals                                                                                                                                                                                                                                                                                                                                      

Different lawmakers have come up with two different pieces of legislation, both referred to as Medicare for All. Both of these Medicare for All programs may be closer to “health care for all” than “Medicare for all,” the New York Times reports.

One of the first lawmakers to put forth the proposal of Medicare for all was Senator Bernie Sanders according to the New York Times. Also known as single-payer health care, Sanders’s Medicare for All proposed having the federal government, not private health insurance companies, provide coverage for all Americans.

Under the current Medicare program, for example, beneficiaries generally pay monthly premiums, and some cost-sharing amounts, like deductibles, copayments, and/or coinsurance. Sanders and Congresswoman Pramila Jayapal propose eliminating those out-of-pocket costs. It wouldn’t involve private health insurance companies, as Medicare currently does in some cases (Medicare Part C and Part D, for example). Sanders’s proposal would include some coverage not typically covered under traditional Medicare today, like routine dental and vision care.

Rep. Jayapal (D-Washington) sponsored a different Medicare for All proposal which would establish a national health budget, per the NYT. It would change the way facilities like hospitals and nursing homes would get paid. Every hospital would get a lump-sum “global budget” payment – somewhat like the way Canada pays hospitals in its national health care system.

Medicare for all: limited expansion

There have been at least two bills that would generally give Americans the option of getting Medicare starting when they’re 50.

  • Debbie Stabenow (D-Michigan) introduced a “Medicare at 50” proposal.
  • Some members of the House of Representatives introduced a Medicare Buy-In and Health Care Stabilization Act of 2019. It would include an option for employers to make pre-tax contributions toward employee premiums, according to Rep. John Larsson (D-Connecticut)’s House web page.

The State Public Option Act

The State Public Option Act would let some people who aren’t currently eligible for Medicaid (not Medicare) buy into a state Medicaid program through the Affordable Care Act. This would primarily be for people who don’t already have health insurance. Qualified people would pay lower cost-sharing amounts and be eligible for a premium subsidy.

Medicare for all: public plan options

These bills would make Medicare-based health plans available to more people according to Kaiser Family Foundation.

  • The Choice Act would add a public health insurance option, similar to the plans available on the federal health insurance Marketplace exchange created by the Affordable Care Act (ACA, also called Obamacare). The plans would be ACA-compliant and may include other benefits besides those the ACA requires.
  • The Medicare-X Choice Act of 2019 would make health insurance available in areas where there are very few (or no) health-care providers or health insurance plans, whether on or off the Marketplace. It would make more people eligible for premium tax credits.
  • The Choose Medicare Act would expand Medicare eligibility to include businesses as well as individuals. Unlike some proposals, the Choose Medicare Act would involve private health insurance, in an effort to increase competition and reduce consumer costs.

Medicare for all: who will pay for it?                                                                                                                                                                                                                                                                                                                                      

The New York Times reports that many of these proposals don’t include details of how the programs will be funded. The Medicare-X Choice Act lays out income-based taxes to help fund the program, affecting those whose income is at least 400% of the federal poverty level.

The average American pays a monthly premium for health insurance that works out to $6,896 per year ($19,616 for a family). That’s what the Kaiser Family Foundation reported in 2018. Some Medicare for All proposals may call for increased taxes. If the average tax increase were under $7,000 per year per person, and you didn’t pay a premium, your costs might balance out.

Medicare for all: will such a bill get passed?

There’s a lot of disagreement about health-care reform, even among those who want Medicare for All, according to the New York Times. Many Democrats support Medicare for All and/or similar health-care reform, but they’re not all on the same page when it comes to which specific bill to support.

As you can see, health-care reform in the United States is a complex and contentious issue. Don’t expect Medicare for All to happen quickly and neatly. For now, Medicare remains available generally only to those who are eligible through age or disability who meet residency requirements.

Are you eligible for Medicare under the current program? You might have several Medicare plan options in your area. Just enter your zip code on this page and start comparing plans today.

It might help you decide if you compare plans available in your area. Or reach out to an eHealth licensed insurance agent.

As of the writing of this article, there are various proposals for Congress to repeal or replace Obamacare, so the situation may change. This article is for general information and may not be updated after publication.

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