Lowering the age for Medicare

[harllee]

There all all kinds of proposals for Medicare for all, for changes to the ACA, etc. But I am not hearing anything about lowering the age to get Medicare. There was some discussion on this when the ACA was first proposed but it did not go anywhere. It seems to me that the older you get the more medical issues you have which costs private insurers more. Why not give people an option at 55 or 60 to purchase into the Medicare system? Such people could pay more than the current Medicare rates but it would probably be much cheaper than private insurance. The private insurers would probably like the idea because they could get rid of older, sicker people. There would certainly be a cost to this but it would bound to be cheaper than Medicare for all. I don't want to this to be a political discussion but more one of cost v benefit and policy. This idea makes a lot of sense to me. Thoughts?

 

[JustCurious]

I don't want to this to be a political discussion...

You may not want it, but I don't think it's possible to discuss this topic without it becoming political.

 

[Beststash]

As someone that Fire'd at 52 (2003) with the understanding that my former employer would provide medical insurance pre-Medicare and then reneged, I would have loved to have had access to Medicare. Because of a pre-existing condition (glaucoma) I was forced to enroll in the Texas high-risk pool until 2011 when ACA became available. It seemed an extraordinary expensive solution then and the ACA was welcome.


I think making Medicare available 55 and up would be a good proposition but considering the political climate these days I question what, if anything, would pass these days.

 

[davebarnes]

How about:
* lower the Medicare age by 1 year per year for the next 5 years
* raise the Medicare tax by 9 basis points per year
?
At the end 5+ years let’s see where we are.

 

[HtownRose]

I think I have heard this idea mentioned in one of the DNC debates or related commentary. Instead of kicking everybody off their existing plan & into MFA, offering it to those x years younger than age 65. Mayor Pete maybe?

"Medicare For All Who Want It" or "public option" is also being discussed.

 

[BeachOrCity]

Unless and until one party controls the house, the senate, and the presidency nothing will get done on this topic.

When one party controls all three I think we all know the general direction things would go in based on history.

Last time all three were blue we got the ACA. Public option was discussed and dropped based on narrow margins it could not get passed.

Last time all three were red we (almost) got ACA repealed with no actual replacement as part of the proposed repeal. No discussion of public option at all.

My advice is assume status quo unless and until one party has all three.

 

[ShokWaveRider]

You may not want it, but I don't think it's possible to discuss this topic without it becoming political.

Of course it can. The OP's comments have Zero to do with politics, unless someone makes it so.

Anyway, I think it is a great idea. I think the Medicare age should simply be reduced to 60 based on some ACA type rules on income etc. Premiums could be on a sliding scale till 65. Medigap could still be purchased if desired.

 

[MRG]

How about:
* lower the Medicare age by 1 year per year for the next 5 years
* raise the Medicare tax by 9 basis points per year
?
At the end 5+ years let’s see where we are.

Why a phased rollout? Do you think it's not possible to predict the end result from previous data? I don't know.

 

[harllee]

Of course it can. The OP's comments have Zero to do with politics, unless someone makes it so.

Anyway, I think it is a great idea. I think the Medicare age should simply be reduced to 60 based on some ACA type rules on income etc. Premiums could be on a sliding scale till 65. Medigap could still be purchased if desired.

OP here, thanks this is exactly the kind of thing I was thinking of. The big issue would be financing it --the sliding scale idea for premiums is a good one. I wonder if anyone has ever done a cost analysis on this.

The good thing about Medicare is that the system is already in place. I am over 65 and on Medicare and for the most part I think it works very good.

 

[Retiree_Having_Fun]

When states pass laws that eventually might be good for the entire nation but not everybody is sure, state laws allows small amounts of experimentation with throwing out the status quo.

Things like Romneycare, pot laws, gambling were decided at the state level. Nevada has land based gambling while some other states allow gambling on boats. Pot laws have been changing starting with decriminalization and now open sales in some states.

Medicare would be difficult to change in one state since it's a federal program. Tweeks could be tried as suggested and results measured without throwings people off insurance programs that they fought for (unions) or are as part of their compensation. The problem is that government doesn't do a good job changing, measuring and revisiting issues due to political realities. Sometimes the good intentions of government end up with opposite results. Look at rent control and prohibition.

The reality is that even small changes are difficult - look at the Surprise Medical Billing as an example.

 

[Bir48die]

When states pass laws that eventually might be good for the entire nation but not everybody is sure, state laws allows small amounts of experimentation with throwing out the status quo.

Things like Romneycare, pot laws, gambling were decided at the state level. Nevada has land based gambling while some other states allow gambling on boats. Pot laws have been changing starting with decriminalization and now open sales in some states.

Medicare would be difficult to change in one state since it's a federal program. Tweeks could be tried as suggested and results measured without throwings people off insurance programs that they fought for (unions) or are as part of their compensation. The problem is that government doesn't do a good job changing, measuring and revisiting issues due to political realities. Sometimes the good intentions of government end up with opposite results. Look at rent control and prohibition.

The reality is that even small changes are difficult - look at the Surprise Medical Billing as an example.

I like the sentence "might be good for the country" on states passing laws. Agree the Feds are just so bound up that they could not even consider passing anything meaningful.

Not sure where I stand on lowering the age. I have had to pay a lot these last few years. However this is a very expensive program and once again putting the burden on those that are younger to finance people retiring early and healthier than ever

 

[Aerides]

I do think some idea of lowering the age, perhaps with a sliding scale on the premiums, makes sense, and, of course, selfishly, would fully endorse.

Over 55 (and over 50 even) folks who become unemployed have a harder ability to become re-employed full-time with benefits vs. younger workers. Remaining gainfully full-time employed until 65 isn't very realistic in a lot of professions.

But the ACA did somewhat solve for this (costs-aside) by removing the pre-existing barrier that forced many older workers to keep going till 65. So Medicare isn't necessarily cheaper or better for many of these folks - it depends by state, plan, income, etc. While not common, we've all seen posts from people here who saw their premiums go up when they switched from the ACA to medicare.

So if you attack this from "what problem are you trying to solve" - lowering Medicare eligibility only makes it easier for a small target group. And by letting more people in, there is concern that costs might go up for all - so there will be pushback (IE, votes against) from those already on it or about to be. You can imagine the ads that will circulate...

The problem currently being talked about most is cost, which impacts a much larger group - basically anyone not getting big-employer-subsidized HI. So a plan that only solves the problem for a small segment isn't going to gain much traction any time soon.

 

[Independent]

As someone that Fire'd at 52 (2003) with the understanding that my former employer would provide medical insurance pre-Medicare and then reneged, I would have loved to have had access to Medicare. Because of a pre-existing condition....

I've got a similar story. I retired at 59, my wife was diagnosed with cancer two years later, we got the notice that the company was cancelling while she was doing chemo.

ACA would have been fine with me. We had the income to pay a "normal" ACA premium. I'm not sure how Medicare would have been better.

I think ACA needs some modest modifications -- basically, the individual insurance market picks up some people who aren't working due to health problems and they make the individual pool more expensive than the group insurance pool. That seems like the right place for some taxpayer subsidy.

 

[easysurfer]

....

So if you attack this from "what problem are you trying to solve" - lowering Medicare eligibility only makes it easier for a small target group. And by letting more people in, there is concern that costs might go up for all - so there will be pushback (IE, votes against) from those already on it or about to be. You can imagine the ads that will circulate...

The problem currently being talked about most is cost, which impacts a much larger group - basically anyone not getting big-employer-subsidized HI. So a plan that only solves the problem for a small segment isn't going to gain much traction any time soon.

+1

Trying to solve for one target group gets another upset. The idea of lowering Medicare eligibility age I think is similar to the thought of raising the eligibility age of social security. May address one issue for a target segment but get another segment upset.

 

[harllee]

OP here. I am on Medicare now but I was on the ACA before age 65. My premiums were higher on the ACA than on Medicare and my ACA plan was much inferior to ACA. The ACA plan had a $6000 deductible and a limited network. I was very grateful to get on Medicare at 65. The ACA plans are better than what we had before because of the preexisting coverage but in my opinion the ACA is not working very well. The deductibles are getting larger and the networks getting smaller. Ideally we would have Medicare for all but since that seems unlikely. I really wonder why I am not seeing proposals to expand Medicare to people over 55 or 60.

 

[Midpack]

I do think some idea of lowering the age, perhaps with a sliding scale on the premiums, makes sense, and, of course, selfishly, would fully endorse.

Over 55 (and over 50 even) folks who become unemployed have a harder ability to become re-employed full-time with benefits vs. younger workers. Remaining gainfully full-time employed until 65 isn't very realistic in a lot of professions.

But the ACA did somewhat solve for this (costs-aside) by removing the pre-existing barrier that forced many older workers to keep going till 65. So Medicare isn't necessarily cheaper or better for many of these folks - it depends by state, plan, income, etc. While not common, we've all seen posts from people here who saw their premiums go up when they switched from the ACA to medicare.

So if you attack this from "what problem are you trying to solve" - lowering Medicare eligibility only makes it easier for a small target group. And by letting more people in, there is concern that costs might go up for all - so there will be pushback (IE, votes against) from those already on it or about to be. You can imagine the ads that will circulate...

The problem currently being talked about most is cost, which impacts a much larger group - basically anyone not getting big-employer-subsidized HI. So a plan that only solves the problem for a small segment isn't going to gain much traction any time soon.

+1

Trying to solve for one target group gets another upset. The idea of lowering Medicare eligibility age I think is similar to the thought of raising the eligibility age of social security. May address one issue for a target segment but get another segment upset.

+2. Just because one group wants something, doesn’t mean they should get it if (any) costs are being transferred to others. Younger generations of workers, your children and grandchildren, are probably going to pay more and get less as it is. Seems that simple, what am I missing?

Medicare has been in the red for years. Medicare for all would be very expensive, the proposal in post #1 is just a subset of same.

And I’m guessing the real cost for those 55-64 would be equivalent to ACA for the same group, whereas I think the OP is hoping “early Medicare” would be less. If you want to retire before 65, ACA is a healthcare option...

 

[harllee]

OP here, I don't have any data that supports this but I would guess that the medical costs of those age 55-60 are higher than the general population. If you could remove some of those people from the private insurance pool wouldn't that reduce the costs to private insurance and therefore the insurance premiums? If I remember correctly the insurance companies were in favor of lowering the Medicare age when it was proposed as part of ACA.

 

[harllee]

+2. Just because one group wants something, doesn’t mean they should get it if (any) costs are being transferred to others. Younger generations of workers, your children and grandchildren, are probably going to pay more and get less as it is. Seems that simple, what am I missing?

Medicare has been in the red for years. Medicare for all would be very expensive, the proposal in post #1 is just a subset of same.

And I’m guessing the real cost for those 55-64 would be equivalent to ACA for the same group, whereas I think the OP is hoping “early Medicare” would be less. If you want to retire before 65, ACA is a healthcare option...

OP here, I don't think that that Medicare premiums would be any less than ACA premiums for those in the 55-60 age group. BUT Medicare (with a supplement) has much lower deductibles than most ACA policies (my personal ACA policy had a $6000 deductible) and the Medicare network is much larger than most ACA networks. I don't think that ACA is working very well and I am concerned that it will someday collapse or be repealed.

 

[Midpack]

OP here, I don't have any data that supports this but I would guess that the medical costs of those age 55-60 are higher than the general population. If you could remove some of those people from the private insurance pool wouldn't that reduce the costs to private insurance and therefore the insurance premiums? If I remember correctly the insurance companies were in favor of lowering the Medicare age when it was proposed as part of ACA.

If your really interested, there are lots of articles about it https://lmgtfy.com/?q=lowering+medicare+age&s=g&t=w

 

[Midpack]

OP here, I don't think that that Medicare premiums would be any less than ACA premiums for those in the 55-60 age group. BUT Medicare (with a supplement) has much lower deductibles than most ACA policies (my personal ACA policy had a $6000 deductible) and the Medicare network is much larger than most ACA networks. I don't think that ACA is working very well and I am concerned that it will someday collapse or be repealed.

The premiums won’t be the same unless the deductibles are the same, risk pooling isn’t rocket surgery.

 

[karen1972]

I've never been clear what the actual cost per month Medicare actually costs to maintain. I have a hard time believing it costs more than what the plans on the ACA cost. A single person in my area at age 63 has the cheapest option being $700/month (which gives them access to a teeny tiny amount of doctors and hospitals, 1 actually of the 12 in the area) So that is the question, does Medicare cost less than $700/month (including all the parts) and if so then lowering Medicare age is better for everyone, since otherwise we are subsidizing more to an insurance company than necessary while limiting choice.

I also wondered if there would be any offset by lowering the age. I know a lot of lower income people who delayed things like knee surgeries until they were on Medicare as their prior insurance made it un affordable, so they enter the system with a whole list of existing conditions that now need to be treated. Conditions that if treated may have enabled them to work more and put more money back into the system.

 

[Another Reader]

It's always seemed odd to me that you can get Social Security at 62 but have to wait until 65 for Medicare. If most people that take Social Security early do so because they need the money, perhaps they can be covered under a low cost ACA plan or Medicaid. However, people that need to take Social Security early may not be able to qualify for or afford the low cost subsidized premium ACA plan or they may live in a state that did not expand Medicaid.

People on SSDI qualify for Medicare after a 24 month waiting period independent of age. Maybe including people that take Social Security early for financial reasons in Medicare would make sense. Not sure how that would work, though.

 

[Major Tom]

It's always seemed odd to me that you can get Social Security at 62 but have to wait until 65 for Medicare. If most people that take Social Security early do so because they need the money, perhaps they can be covered under a low cost ACA plan or Medicaid.

If we ever get to the point where expanding Medicare coverage by lowering the age of eligibility starts to happen, this would seem to be a logical first step. I think many folk (me included) have pondered on the age gap between early SS and the onset of Medicare eligibility.

 

[USGrant1962]

OP here, I don't think that that Medicare premiums would be any less than ACA premiums for those in the 55-60 age group. BUT Medicare (with a supplement) has much lower deductibles than most ACA policies (my personal ACA policy had a $6000 deductible) and the Medicare network is much larger than most ACA networks. I don't think that ACA is working very well and I am concerned that it will someday collapse or be repealed.

Medicare spends $11,000 per person per year, so you could assume that is what a "buy in" would cost. Maybe a little less for 55-64, but still makes ACA look good.

 

[MichaelB]

I've never been clear what the actual cost per month Medicare actually costs to maintain. I have a hard time believing it costs more than what the plans on the ACA cost. A single person in my area at age 63 has the cheapest option being $700/month (which gives them access to a teeny tiny amount of doctors and hospitals, 1 actually of the 12 in the area) So that is the question, does Medicare cost less than $700/month (including all the parts) and if so then lowering Medicare age is better for everyone, since otherwise we are subsidizing more to an insurance company than necessary while limiting choice.

I also wondered if there would be any offset by lowering the age. I know a lot of lower income people who delayed things like knee surgeries until they were on Medicare as their prior insurance made it un affordable, so they enter the system with a whole list of existing conditions that now need to be treated. Conditions that if treated may have enabled them to work more and put more money back into the system.

Medicare spent $10739 per person in 2017, according to CMS https://www.cms.gov/research-statis.../nationalhealthexpenddata/nhe-fact-sheet.html


Average premium for a large group employer policy in is $7188 (age neutral, link here). While there is no average ACA policy cost to compare, a policy with a broad network in Florida, such as BCBS BlueCard, is around $2.3K per month with a low deductible.

To compare ACA with Medicare, one would need to add the cost of Supplemental and drug coverage to Medicare. If that were $350 per month, the total cost of Medicare coverage would increase to $15.3K per person, about half the cost of ACA coverage for >60 year old.


That cost difference has many reasons, but the biggest driver is probably a disproportionate number of sick people on the ACA policy. Medicare, OTOH, has the entire eligible (age 65+) population enrolled.


Without expressing an opinion on the OP question, my guess would be the additional cost of covering more younger people on Medicare would be similar to the cost of employer large group coverage today, or around $7.2K per person.