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(CNN) - Many Democrats running for the 2020 presidential nomination want to secure more people by expanding Medicare to cover all Americans.
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But if Senator Bernie Sanders’s comprehensive “Medicare for All” plan was enacted, it would mean major changes for the more than 60 million people who are already enrolled in Medicare, the federal health program for the elderly and disabled.
While the Vermont senator argues that his proposal would provide even more benefits for the elderly, others, particularly former Vice President Joe Biden, have warned that he would transform the 53-year program beyond recognition, despite keeping the name intact.
"Medicare disappears as it is known," Biden said in July at an AARP candidate forum. "All the Medicare they have is gone."
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The question is whether that is better or worse for older people whose coverage would change, although the likelihood of Congress enacting a Medicare program for all also depends on whether Democrats win the Senate in 2020.
Other candidates also use the term "Medicare" in their health care proposals, although most are actually launching government-managed insurance plans, known as a public option. These reforms would be aimed at those who are not yet eligible for today's Medicare program.
Democratic contenders evoke Medicare because it is a much-loved federal program. About 82% of respondents had a "very favorable" or "somewhat favorable" view of Medicare, according to a July survey by the Kaiser Family Foundation. And 95% of those with Medicare rate their coverage as "excellent" or "good," according to the survey.
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“Biden is not wrong. Sanders is getting rid of Medicare, ”said Christopher Holt, director of health care policies at the American Action Forum, a conservative group of experts. “I understand why Sanders doesn't like that frame. Older people are particularly sensitive to changes in their benefits. I can also understand why Sanders thinks it's unfair, because he thinks he's giving them something better. ”
Currently, many Medicare members have to pay premiums, deductibles and a portion of the doctor's charges and prescription drugs. Unlike those with employer-sponsored coverage or low-cost Health Care Law plans, Medicare beneficiaries are not protected by annual out-of-pocket limits, so those who are sick may be charged with large invoices.
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To help with that, millions of Medicare members also have some type of supplemental insurance provided by their former employer or purchased from private insurers.
Older people also currently have the option to enroll in Medicare Advantage plans, which are sold by private insurance companies and provide a limit on out-of-pocket costs. Policies also usually offer additional benefits, such as dental care, eye exams, or fitness programs. But they generally have fewer doctors in their networks and can include a more complicated medical care approval process than traditional Medicare. More than a third of the beneficiaries enrolled in one of these plans in 2018.
According to Medicare for all, older adults, like all Americans, would be enrolled in a government-run plan with very broad access to doctors and have no premiums, deductibles or out-of-pocket expenses. Sanders has acknowledged that some would be subject to higher taxes, based on their income, to pay for the program. Essentially, private insurance, including Medicare Advantage plans, would be eliminated.
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Sanders has accused Biden of using "wrong information" to attack his plan, which the senator says would provide elders with access to a greater variety of benefits.
“I hope seniors will hear this: we’re going to expand Medicare benefits for seniors to include dental care, hearing aids and glasses, which many seniors today cannot afford because Medicare doesn’t cover those benefits and we will provide those benefits, ”Sanders in a campaign video in July.
The Biden campaign, however, says older people should know that the current Medicare program would change according to the Sanders plan. They would no longer have the option of choosing a private Medicare Advantage policy, for example, said a campaign staff member.
The former vice president's plan would leave Medicare intact, along with private insurers that offer Medicare Advantage plans, but would give younger Americans the option to enroll in a government-administered policy, which he calls "a public health insurance option such as Medicare ”, if I don't like your current coverage.
He wants to take advantage of Obamacare and not discard existing coverage programs.
"Obamacare is working," Biden said in the CNN debate in July. "Nobody has to keep their insurance private, but if they like their insurance, they should be able to keep it ... if they don't, they can buy the Biden plan, which is Obamacare."
Bernie SandersJoe BidenMedicare
