The Road Less Traveled: Medicare and the Medicare Savings Programs as a Potential Solution for the Underinsured Immigrant
Every year, the National Asian Pacific Center on Aging (NAPCA) receives over 9,500 phone calls through a national, toll-free, Asian language Helpline from limited and non-English speaking seniors needing help understanding benefit programs for which many are eligible but unable to access.
Mrs. Pang and Mrs. Taduran (not their real names) represent thousands of immigrant seniors in the United States, who are legal permanent residents but have little or no work history in this country and go without adequate healthcare because they cannot access affordable insurance. Many are eligible for Medicare or Medicare Savings Programs but are unaware of their eligibility.
Mrs. Pang, a Chinese grandmother living in Seattle, was worried that Medicaid would not cover her health care costs while visiting her grandchildren in Los Angeles. She was right to be worried because as a Washington State resident, her Medicaid was issued by Washington State and so she had no Medicaid coverage outside of the state.
Mrs. Taduran emigrated from the Philippines with her daughter and her family so she could care for her grandchildren while her daughter and son-in- law worked. Mrs. Taduran had no health insurance because her household income was too high to qualify for Medicaid yet far too low to afford private health insurance premiums. A few years later she began to have blurred vision but didn’t tell anyone since she knew her family couldn’t afford a doctor.
Medicare, a federal program, may be a potential solution for seniors like Mrs. Pang and Mrs. Tadurann. An individual may be eligible for Medicare if he or she is (1) at least 65 years of age or disabled and (2) a U.S. citizen or have legally resided in the US for 5 years continuously and have legal permanent resident status.
How does this help Mrs. Pang? As a Medicare beneficiary, Mrs. Pang would receive Medicare covered services anywhere in the country regardless of where she lives. Even in Washington State there would be benefits to having Medicare in addition to Medicaid. Far more service providers accept Medicare than Medicaid so Mrs. Pang would have greater choice among primary care doctors and specialists. Greater choice is critical because some doctors who accept Medicaid often limit the number of Medicaid patients they see or accept visits only during the early part of a month.
In Mrs. Taduran’s case, she was able to enroll in Medicare since there are no income requirements therefore, her household income would not affect her eligibility.
Of course, eligibility for Medicare is only the first hurdle for low income beneficiaries. Without at least ten years of covered employment, which is a challenge for new immigrants, a beneficiary must pay the monthly Part A premium. This is not insignificant since the Part A premium for 2014 is $426 per month. Additionally all beneficiaries pay a Medicare Part B monthly premium of $104.90 in 2014 as well as a Medicare Part D premium that averages about $37 per month. These premiums are in addition to copayments and deductibles that are associated with all parts of Medicare.
Fortunately for Mrs. Pang, Medicaid can cover these costs so she would be fully covered once she enrolls in Medicare.
Because Mrs. Taduran doesn’t qualify for Medicaid, she’ll need to rely on a partial Medicaid program called the Qualified Medicare Beneficiary (QMB) program, which is part of the Medicare Savings Programs. Unlike full Medicaid, QMB doesn’t cover any additional services such as dental or long term care, but it does cover all premiums, copayments and deductibles that come with Medicare. QMB’s higher income and asset limits allow seniors in Mrs. Taduran’s financial situation to access healthcare.
On Medicare, Mrs. Taduran was able to see a doctor who diagnosed her with diabetes. Mrs. Taduran’s blurred vision was the early stage of diabetic retinopathy but with her diagnosis and a doctor’s care she was able to control her diabetes, which prevented her from suffering worse consequences of the disease.
Mrs. Pang and Mrs. Taduran are examples of many diverse elders who encounter added challenges in accessing critical programs that enable seniors to age safely and securely. Language appropriate services such as the assistance provided by the NAPCA Helpline are critical in helping cover the gaps that prevent immigrant seniors from accessing much needed insurance.
Angelo Locsin is the Special Projects Manager for the National Asian Pacific Center on Aging (NAPCA) and oversees Helpline operations and NAPCA’s information systems. The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.