Introduction
Healthcare services for the senior population in the US have increasingly become an unprecedented challenge for the US Healthcare System. Primarily, the healthcare sector acknowledges that older adults above 65 years are vulnerable to terminal illnesses. A majority of the elderly population is predisposed to diabetes, hypertension, arthritis, and mental conditions such as dementia and Alzheimer’s.
Additionally, the healthcare system is alive because the US population is gradually transitioning from a young to an aging one. Statistically, the size of the senior population has increased from 7% to 14% in the past decade (Helwig). By 2030, the aged population is projected to constitute 20% of the entire population (Helwig).
Even with Medicare plans, there is an evident disparity in access to healthcare services among older people. This is due to the high cost of Medicare Plans, illiteracy, and confusion about the Medicare structure. Addressing these barriers cultivates a healthy elderly generation while easing pressure on the healthcare system.
Confusion about Medicare
One of the top causes of healthcare challenges among seniors is confusion about Medicare. Medicare has existed since 1965, when it was signed into law by President Lyndon Johnson. Since then, the insurance plan has undergone numerous policy reforms to increase coverage and accommodate a larger low-income and elderly population. While the changes are meant to improve access to healthcare services, the elderly population, who need it the most, are left confused.
For example, Medicare stipulates specific eligibility requirements for the elderly population. Most people understand that as long as they are over 65 and qualify for Social Security benefits, they can access Medicare Health benefits. However, the program is underpinned by stringent regulations on contributions to premiums and copayments, and by complexities for those with spouses (Herd 134). These ever-changing aspects create so much confusion, forcing older adults to choose the simplest package and limiting their access to services.
In addition, the elderly population is overwhelmed by the various parts of the Medicare plan. From general knowledge, there are Parts A, B, C, and D. The provisions under each are not clearly explained to the elderly population. A Medicare Resources study found that 3 out of 10 older adults cannot correctly identify healthcare services provided under Parts A and B (Fong, e0222539).
This finding is alarming because the two parts are the most basic that anyone aged 65 and above should understand. In line with this, extensive research indicates that older adults are overwhelmed by robust advertising that fails to simplify the components of Medicare (Herd 137). As a result, more senior people refrain from taking up premiums due to a lack of understanding and fear of falling prey to marketing agents. Ultimately, this limits their access to primary care and specialized treatment for chronic diseases.
Illiteracy
Low literacy levels are a proven challenge in healthcare among seniors in America and worldwide. The elderly population is fraught with healthcare illiteracy because they cannot read about their health conditions. Older people cannot research how to manage lifestyle conditions as well as the youthful population. The lack of information impedes personal efforts to lead a healthy life and seek medical services when needed.
Healthcare service providers, on their part, are not keen to educate older people about health choices that could improve their recovery. In line with this, healthcare service providers have failed to inform the elderly population about the importance of medical insurance. According to the National Library of Medicine, of the 12 million people enrolled in Medicare, only 5% are older (Rosenberg, Alex, and Ashford). Given the surge in chronic and terminal illness, the statistic indicates a massive gap in the available information to help older people access Medicare-insured health services.
Illiteracy as a barrier to healthcare access for the elderly generation stems from a lack of information about preventive care. Healthcare Advance reports that attention has recently shifted towards payer programs rather than integrated prevention. For younger patients, healthcare providers can recommend telehealth to increase access (Curto 318).
Elderly generations are generally underrepresented in adopting telehealth for check-ups, follow-ups, symptom tracking, and other healthcare services. Older people need to be better informed about telehealth services and how they may improve access to healthcare. They need to be more conversant with using telehealth resources to consult, learn, and integrate preventive care, which exacerbates the lack of access to healthcare services.
Affordability
Older people are characterized by low to no income to sustain their daily living expenses. The majority of the elderly population is retired and therefore not actively working to earn income. In response to this realization, Medicare was enacted to provide a system through which older people can still receive medical care without the overwhelming burden of costs. This has been achieved to an extent, as older adults can now access healthcare compared to before Medicare came into existence.
However, there is still a huge healthcare access gap attributed to the high cost of Medicare Premiums. The unaffordable Medicare premiums stem from the design of the different packages within the individual parts. For instance, elderly patients must pay for a specified period before qualifying for wholly paid services. While Part A provides extensive coverage, Part B requires patients to pay a premium of up to 20% for physician and ambulatory services (Curto 318). This structure makes Medicare largely unaffordable, thus limiting access to essential health services.
In addition, Part A provides access to primary care, but elderly individuals need long-term care. The Medicare Insurance Plan excludes prescription, dental, and vision care, which are in high demand among older people. Elderly patients have to pay out of pocket for surgeries, emergency care, and at–home visits, resulting in a high cost of health care.
On average, older adults spend far less than the rest of the population on acute care services due to financial limitations (Rosenberg, Alex, and Ashford). As most older adults know that insurance does not cover the services they need, they easily opt out of the programs. Most of them learn to live with chronic illnesses as they do not want to burden their families. Eventually, they die of the diseases or end up getting admitted for long periods as the conditions become unmanageable.
Possible Solutions
Efforts to address the challenges older people face in accessing healthcare services must be based on providing information. As demonstrated, the elderly population is sidelined when it comes to knowledge and information about their health and healthcare premiums. Healthcare stakeholders should work to raise awareness of chronic diseases in older age. This should entail home management, seeking medical attention, and embracing recovery post-treatment (Rosenberg, Alex, and Ashford).
To increase healthcare access, stakeholders in the healthcare sector should use the Medicare structure. So far, it has been proven that Medicare is complex in terms of eligibility criteria and what is covered for different patients. Simplifying it will encourage elderly adults to enroll in plans they can afford to access healthcare.
Finally, there needs to be subsidies for healthcare services that elderly patients copay with the insurance providers. As noted, Medicare has made primary care accessible to older people. While this is commendable, it is essential to note that healthcare needs among the elderly primarily address chronic and acute illnesses.
Industry players may work to subsidize premiums for acute and chronic conditions. This is in consideration of the fact that older people do not have an income; it is not fair for them to become a burden to their families, and they must be treated with dignity. Therefore, the focus should be on increasing access to care for chronic diseases.
Conclusion
Given this, the elderly population is inarguably marginalized in terms of access to healthcare services. Older people are naturally predisposed to age-related illnesses and the aging process. The older generation primarily cannot seek healthcare information to support their well-being. They cannot work to earn a decent income to pay for escalating medical bills. For these reasons, they are unable to access medical care services.
Medicare, which has long served Americans, has partly solved the problem, but more and more older adults succumb due to a lack of medical care. Improving this should include disseminating information, making healthcare affordable, and simplifying Medicare plans. This will help to improve the health outcomes of older people.
Works Cited
Curto, Vilsa, et al. “Healthcare Spending and Utilization in Public and Private Medicare.” American Economic Journal: Applied Economics, vol. 11, no. 2, 2019, pp. 302-332.
Fong, Joelle H. “Out-of-Pocket Health Spending among Medicare Beneficiaries: Which Chronic Diseases are most Costly?” PloS One, vol.14 no. 9, 2019.
Helwig, Amy. “Six Keystone Improvements to Address Surge in Older Adults Living Longer.” RTI Health Advance, 2022.
Herd, Pamela. “Making Medicare Complicated: How Privatizing Medicare is Increasing Administrative Burden for Beneficiaries.” Public Policy & Aging Report vol. 31 no. 4, 2021, pp. 133-138.
Rosenberg, Alex, and Kate Ashford. “What Is the Medicare’ Donut Hole,’ or Part D Coverage Gap?” Nerd Wallet, 2023.