Senior underinsurance is often overlooked

December 11, 2015 § Leave a comment

By Melissa Shannon, Director of Government Relations & Public Affairs, Commonwealth Care Alliance

Massachusetts is known for being a leader in healthcare access.  Everyone knows that our 2006 healthcare access law, known as Chapter 58, was the model for the federal Affordable Care Act.  And, most Baystaters know that we boast the lowest rate of uninsured in the country, 4% in 2014, compared to 10% nationally.[i]  But, one significant segment of our population was left out of those developments: seniors.  The prevailing thought at the time our health access law was being developed was that we don’t need to worry about seniors, because almost all of them qualify for Medicare.

Gaps in seniors’ coverage
While it’s true that most seniors qualify for Medicare, there is still a lot to worry about.  At an event in September, the Blue Cross Blue Shield Foundation of Massachusetts kicked off a worthy dialog that focused health policy makers’ attention on the gaps in seniors’ coverage.  The Foundation reported that seniors who are low-income but not poor enough to qualify for MassHealth face staggering cost sharing for their healthcare coverage – for premiums, deductibles, some prescription costs, and many uncovered services.  In fact, average out-of-pocket costs for Medicare members stand at $7,208 annually, 45% of the average social security income in Massachusetts[ii].  And, there are many Massachusetts seniors who do not qualify for Medicare at all because of their immigration status or other reasons.

Seniors are rightly worried about being able to pay for the care they need, according to recent polling data presented at the Blue Cross Blue Shield Foundation event.  22% of all seniors in Massachusetts are not confident that they have the money or the health insurance they need to pay for healthcare they may need in the future.  11% of seniors in poor health report having to sacrifice all or most of their personal savings to cover their medical bills. 23% of seniors report the problem getting worse over the past five years. And, not surprisingly, 16% of seniors are dissatisfied with the healthcare system in Massachusetts. The dissatisfaction rate is even higher among seniors in poor health.

Efforts to raise MassHealth eligibility
Our colleagues at the Massachusetts Senior Action Council have a sensible proposal that is long overdue to protect the most financially vulnerable seniors:  raise the eligibility for MassHealth to help more truly low-income people cover their out-of-pocket costs. Currently, to qualify for MassHealth as a senior, your income needs to be no more than $11,670 and your assets cannot exceed $2000, the limit set in 1981. In contrast, there is no asset limit for people below age 65 to qualify for MassHealth, and those individuals can have income up to $16,107 a year.  This means that many people hit a healthcare cliff when they turn 65 by losing their MassHealth coverage.

The legislation put forth by the MassSenior Action Council and sponsored by Representative Garlick and Senator Wolf (House Bill 989 and Senate Bill 371, respectively) would increase the asset limits to align with the federal low income subsidy program: $8,780 for individuals and $13,930 for couples.  The legislation would also raise the income limits to $15, 754 annually, and both limits would rise with inflation. To ensure the health and economic security of low income seniors in Massachusetts, Commonwealth Care Alliance (CCA) urges the passage of House Bill 989 and Senate Bill 371.

We at CCA have members who lose eligibility for MassHealth when they turn 65 and are therefore not eligible for Senior Care Options or One Care. We also all know that some individuals are poor, but not poor enough to quality for MassHealth and therefore cannot take advantage of the integrated, person-centered health care we provide.

The time has come to correct this situation and make sure that more Massachusetts seniors have access to the care they need. We hope you will join us in supporting HB 989 and SB 371.

[i] Kaiser Family Foundation State Health Facts, 2014

[ii] The State of Coverage to Supplement Medicare in Massachusetts, Nancy Turnbull, as presented at the BCBS Foundation event September 24, 2015

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