This is the seventh in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future.
I once thought that when I signed up for Medicare, I would never again have to worry about paying for health care. But I will. Medicare's future shape and substance is uncertain. My parents both lived long lives with relatively few illnesses, but when they did get sick, they counted on Medicare and a Medigap policy that plugged any coverage holes. They could never have afforded a prolonged major illness without them. I will not be that secure.
Medicare has never been able to say no to doctors, hospitals or sellers of medical technology, so these providers have gradually gotten the upper hand when it comes to payments, even for treatments that have not been proven effective. Costs are spiraling out of control. Today, politicians and ideological opponents of social insurance want to solve this problem by shifting more of the cost of care to beneficiaries themselves. They want us to have more skin in the game and discourage us from using too many medical services, instead of more tightly controlling the costs of treatment, which would anger powerful stakeholders. The Congressional Budget Office said that a plan to privatize Medicare crafted by Republican Congressman Paul Ryan of Wisconsin would mean that seniors, on average, would pay about 68 percent of their health care costs out-of-pocket compared with the about 39 percent they now pay. Not many seniors can afford to pay that much, especially when half of them have incomes less than $22,000 a year.
The bottom line is this: My out-of-pocket spending will undoubtedly go up if for no other reason than that the cost of care will continue to increase. But it's a good bet Congress will continue its drive to make beneficiaries pay much more, and I along with millions of others will get caught in whatever unfavorable changes Congress makes. There's a chance that Congress will slip into a bill to raise the debt ceiling new legislation that could bring on more out-of-pocket costs for all seniors, those who need Medicare in the future and those who currently have Medigap policies
What will be my options if my former employer decides to drop its policy for retirees when the health reform act outlaws the so-called Cadillac plans with their comprehensive coverage? Will Medigap plans offer comparable security? The future for Medicare Advantage (MA) plans is also uncertain, given more reductions in government subsidies that those insurers now receive. MA plans that survive probably won't be the good deals they are today. Eventually, they too will require seniors to pay more. So the options for covering Medicare's coverage gaps in the future are a big unknown, and that leads to high medical expenses that I and millions like me may not be able to pay.
The political winds are blowing in a direction that will tear apart Medicare in favor of the private market. As readers of this series know, choosing an option to cover the gaps from private market insurers is neither quick nor easy. Yet Medicare is likely to become more privatized with benefits sold by insurance company behemoths dominating the market and setting the prices and coverage. Just the other day UnitedHealthcare, the giant that was most persistent in trying to snag me as a customer, tried for a final time. I got a Dear Friend letter warning that my time to enroll in a Medicare health plan is running out. Don't miss out, the mailing screamed. Enroll today. One thing is certain: the marketplace never changes.