Editor's note: Journalist Philip Moeller is here to answer your questions about aging and retirement. His weekly column, "Ask Phil", aims to help older Americans and their families by answering their financial and health questions. Phil is the author of the new book, "Get what you need for Medicare" and co-author of "Get what belongs to you: Revised secrets to maximize your social security." Send your questions to Phil.


Now that the Democrats have taken control of the US House of Representatives, they have promised to hold hearings on proposals tending to bring the US to the type of universal health care existing in others. industrialized countries, including our northern neighbors in Canada. These proposals range from extending the current Medicare program to those aged 55 and over, to a single payer system that eliminates insurance companies and employer-provided health insurance.

No less than eight proposals have been put forward so far and others will surely follow.

To be clear, with the Republicans in charge of the Senate and the White House, there is no chance for ambitious plans to be adopted. Even if the Democrats were to take control of the White House and both Houses of Congress in 2020, it is unlikely that we will see any substantial progress towards universal health in the near future.

Any serious effort to change the way we pay for health care will take years of research and discussion.

Look at how long it took the Democrats to enact the Affordable Care Act. Congress passed the law only two years after the inauguration of President Barack Obama, and lawmakers had already debated similar health proposals for decades. The implementation of Medicare for all would probably take even longer, since it is a much more consequential revision than that of the ACA. .

Moreover, on both sides of the political spectrum, any major change in the country's health insurance system would require bipartisan support to avoid the political and legal chaos surrounding the ACA since its adoption.

With such a delay, it would be easy to see the House Democrats' current program in health as a child's game – President Trump wants his wall; Democrats want to develop affordable health care.

There is undoubtedly some truth to this point of view, but it is still possible that a "lite" measure of Medicare-for-All could be adopted without the lengthy process that accompanied the ACA. Extending health insurance to people aged 55 to 65, for example, may not disrupt other markets and provide a good transition for wider change.

It is also true that any serious effort to change the way we pay for health care will require years of research and discussion. Moving on to work, now, it's barely jumping the revolver. It is also essential to draw attention to the different ways of changing the system to inform citizens of the challenges of their vote in 2020.

Here is a chart with a brief overview of what each proposal entails.

Medicare proposals for allFor a more in-depth review of each of the eight proposals, the Kaiser Family Foundation has a thorough explanation as good as an interactive tool this allows people to see more detailed side-by-side comparisons of different proposals.

Tricia Neuman, head of Kaiser's Medicare policy team, told me that the eight plans represent a very early stage in what will likely be a prolonged period, marked by more research. hearings and proposals. The proposals themselves are more statements of intent than fully defined plans. This is especially true when it comes to their price tags.

For example, three of the plans to expand Medicare would not raise taxes but would force people to pay for the new coverage. The current health insurance program would not be affected by the proposals. Given that current Medicare beneficiaries pay much less for their care than costs, the adoption of any of these proposals would create much higher premiums for enrolled youth. Such details, which have little effect, remain to be clarified.

In addition, the Congressional Budget Office has not yet "rated" these plans, which implies an estimate of their budgetary impact. When that happens, you will know that Congress has finally taken the legislative process seriously.


And now for some reader questions.

Christine – South Carolina: I've been a Medicare member for 20 years, but recently I received a letter from Social Security saying that I was fired because I was no longer considered disabled and my disability benefits and Medicare eligibility would end. I have no idea where this comes from because I am diagnosed with high blood pressure and post-traumatic stress disorder, major depression and related mental illnesses. I need several prescription drugs, but I can not afford to pay all my bills and I think I will need food stamps. I am well below the poverty line, but they say that I will also lose my Medicaid. Phil, help me please. I am terrified.

Phil Moeller: I'm really sorry to hear about your problems. Being touched by all these problems at once can be overwhelming. I do not have a miracle solution here, but some ideas.

the Health Insurance Public Assistance Program (SHIP) provides free Medicare and Medicaid advice. I would call or contact the South Carolina SHIP office and see if he had any ideas for resource recommendations to help you. I would ask them if they know pro bono lawyers who could help you challenge the Social Security decision to remove you from your disability.

You may be able to purchase health insurance from the South Carolina Insurance Exchange. here is a link where you can start.

South Carolina has addiction programs that could help you. here is a link to know more.

If you have not done so already, I would also call your main doctors' offices to ask for help during this very difficult time for you.
I would like to have more ideas.

Please let me know how things are going. My best wishes are with you.

Laura – Connecticut: Is Medicare free for people 65 and over?

Phil Moeller: That would be nice, but the answer is no.
Part A of Medicare, which covers hospital and nursing home care, does not charge any premium to anyone who has worked long enough to qualify for social security. But it's not free because there are deductibles and fees for long stays.

Medicare Part B, which covers doctors, outpatient fees and medical equipment, bills most people a monthly premium of $ 135.50 in 2019 and an annual deductible. In addition, it pays only 80% of covered expenses.
Private Medicare D plans, Medicare Advantage plans and Medigap supplement plans also cost money.

Very poor people who qualify for Medicare may be eligible for Medicaid, who would then have to pay for their medical care. These people are referred to as "eligible dual beneficiaries" because they are eligible for both Medicare and Medicaid.

Jack – Florida: My wife, 75 years old, went to the hospital by ambulance EMS. She had a medical emergency. Later, EMS sent us a bill over $ 700 and said that Medicare had rejected this request. However, his health condition required ambulance. Only three days later, she was called back to the hospital and admitted. We live in a very rural area without emergency transportation. EMS doctors have not said anything about Medicare that does not cover this route. We would like to appeal the denial and ask if you can suggest a strategy?

Phil Moeller: I sympathize with your situation but, unfortunately, I have no good suggestion for your call. If his doctor confirmed that his situation was in danger of death, it might help. However, Medicare may very well refuse ambulance requests and the agency is particularly sensitive to this issue due to repeated abuses of this benefit by ambulance operators and, possibly unintentionally, by Medicare registrants.

The fact that the doctors of the EMS did not say anything probably does not affect your request. These doctors are supposed to protect your health – do not be experts in Medicare coverage rules.