Medicare is a government-funded health insurance program targeting elderly people 65 years of age and older or those diagnosed with a disability such as renal failure. There are several options to choose from with Medicare but none offer complete coverage without having to pay out of pocket. This can cause problems with elderly people who are on a fixed income. As many older adults reach the age to qualify for Medicare, they are suddenly concerned when they realize their health care coverage is minimal or doesn't offer a well-rounded package that suits their individual needs.
Gap in Elderly Care
One problem with health care is a gap in coverage. This can begin at early retirement if it occurs before age 65. Unless you get a COBRA or some form of private insurance, you will be without medical coverage. The gap can also occur when you sign up for a Medicare option plan and you are without hospitalization or prescription drug coverage. The basic Medicare package, or part B, covers doctor, outpatient and well visits. All health care must be carried out at Medicare approved physicians and hospitals. Most coverage is only 80 percent and the patient is required to pay the remaining amount out of pocket or through a secondary insurance plan. This can be a problem if the elderly patient needs hospital care or skilled nursing care. The cost of a hospital stay can be thousands of dollars and easily and quickly place someone in medical debt. The Centers for Medicare and Medicaid note that even if the patient has Medicare, they still must meet strict criteria before Medicare will pay, as physician approval for surgery and the hospital must be contracted with Medicare and have a written agreement in place. Many skilled nursing facilities will not accept patients who do not have health care coverage or cannot financially pay room and board. This leaves many elderly people out of the realm of health care coverage they need for lifestyle management and survival.
Prescription Medications
Kaiser Edu states that up to 90 percent of elderly people rely on prescription medication regularly. These prescriptions are medical necessities that are used to prevent disease progression or prolong quality of life. If an elderly person does not have Medicare part D, which covers most prescriptions, he could go without important meds that he needs for survival. Many patients rely on samples from their physicians or they pay out of pocket for the cost of their medicine. Some seniors resort to not taking certain pills so they can afford others or they go without food and daily living necessities to pay for medication.
Underinsured
While almost everyone is eligible for Medicare when they turn 65, they can still be severely underinsured. While those who have secondary insurance or pay out of pocket for a Medicare advantage plan have good to 100 percent coverage, not every elderly citizen is able to get additional insurance. Plans can be pricey and contain provisions and loopholes that don't cover the medications or specific care that they may need. The American Association of Orthopaedic Surgeons states that what qualifies someone as being underinsured could be an annual income at or below federal poverty levels, high health plan deductibles or medical expenses that are above their annual income. These factors contribute to those who are insured with Medicare or private insurance still not getting the complete spectrum of care such as preventative visits, prescriptions, surgeries, home health care and hospitalization.
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