Despite the possible needs of older Americans demonstrated in the previous sections, there are already a number of services provided specifically for this population.

8.6.1 Social Security

The Social Security Act of 1935 was aimed at solving the problem of poverty amongst the American elderly. It was modeled after a similar program in Germany. The original premise was fairly simple–workers would pay a portion of their earnings into a fund until retirement. Upon retirement, these workers could then receive monthly payments to furnish a base income. Several other benefits have been added over the years, such as income benefits for those considered disabled, widows, and minor children of workers who die before retiring.

The funds collected from workers are held in a separate fund from the regular federal budget, known as the Social Security Trust Fund. There have been many myths and false statements floating around about this fund for decades. One of the biggest concerns is the trust fund running out of money as more and more workers are living longer and fewer workers are entering the workforce. Most reliable sources state that the trust fund will cease breaking even and begin to spend down the balance sometime between 2035-2040. This does not mean that the fund will “go broke”. It means that the fund, which has been collecting more money each year than it has been dispensing, will cease building a balance, and will begin spending more than it brings in. This does not mean that Social Security will disappear, although this may impact the amount paid to retiring workers. Many solutions are being considered, from raising the retirement age, raising the amount taken from wages, and privatizing the entire program.

8.6.2 Medicare

Medicare is specifically a healthcare program for older adults and is not limited by income level. One way to remember the difference between the two programs is that aid is given to anyone who needs help because they cannot do it on their own; care is given to those who need more regular healthcare assistance. Thus Medicaid is for lower income individuals who need help covering their health needs and Medicare is for older Americans who utilize care more often. Technically, Medicare is for anyone 65 years of age or older, people of any age who have certain disabilities, and those with permanent kidney failure, all of whom may need much more care than the general population.

With how much older Americans utilize medical services, Medicare has become the largest contributor to healthcare coverage in the United States. Since it is not an insurance program for those experiencing lower income and poverty, it is not as integral in helping those without insurance become insured and, thus, has had few major structural changes with the implementation of the ACA.

There are four major parts to Medicare:

1. Part A: Known as hospital insurance, this covers inpatient care in hospitals and can cover hospice and some forms of home healthcare. Workers pay into this through income tax and have no premium.
2. Part B: This is medical insurance that covers outpatient services, physician services, and some home healthcare not covered under Part A. It also pays for supplies that are medically necessary. People enrolled in this part of Medicare pay a monthly premium like they would for private insurance.
3. Part C: Managed care organizations work with the government to provide Medicare Advantage Plans through this part of Medicare. These plans cover both Part A and B benefits in order to give consumers choice in overall coverage and is similar to having private insurance. Many of the insurance providers also cover medication.
4. Part D: This more recent addition is the Prescription Drug Coverage of Medicare and is insurance only for prescription medication. Like Part C, this is provided by private companies and consumers incur a monthly premium. However, it can help reduce costs for medications that would normally have to be paid out-of-pocket.

Medicare is by no means perfect, as the various parts of the program are coordinated differently and can be confusing for those utilizing the benefits, specifically Parts C and D (Kronenfeld, 2011). It also does not cover treatment in long-term care facilities, which is of important concern for some of those eligible for Medicare (Austin & Wetle, 2012). However, it is still a prominent piece in the continued coverage of people who have reached retirement age and may have lost their insurance when they stopped being employed. As our older adult population only gets bigger, Medicare figures to continue playing an important role in how this group pays for their medical needs.

Where policy fails, social work has a responsibility to intervene on behalf of all those who live in the United States and do not have that access to affordable healthcare. We need to still be aware of those community resources that are available to client systems that have little or no coverage. In policy practice, we need to help evaluate the implementation and effects of the ACA, recommend and work for any needed positive changes, and assist state and local governments and agencies to ensure the law is being implemented correctly.

8.6.3 Medicaid

Medicaid offers a healthcare coverage solution for low-income individuals and families, including children, those who are pregnant, people experiencing a disability, and those older adults the government considers “seniors.” However, otherwise uninsured healthy women and children have historically made up the majority—70%—of those enrolled in Medicaid programs (Kongstvedt, 2009).

Medicaid is a fee-for-service coverage program, limiting how much state governments pay directly to providers for specific services. Many states even work with managed care organizations to provide care through a network of various providers, which is how the vast majority of Medicaid recipients are served (Centers for Medicare & Medicaid Services, n.d.). Medicaid has been expanded by the ACA to allow more Americans to utilize these programs and provide options for states to further increase eligibility requirements as they see fit. Of course states still have much say in how they implement these programs. However, the passing of the ACA has allowed the federal government to increase eligibility, expand coverage, and adjust minimum regulatory drivers behind the program to reduce the number of uninsured Americans that are not receiving the care they deserve or require.

The changes made to these programs align with the new legislation’s foundational ideas by improving quality of care and expanding treatment, especially for those who have historically received lower levels of service from healthcare providers. Those covered under these programs may still have nominal copayments, coinsurance requirements, deductibles, and premiums—including for prescription medication and emergency room visits—but how much they pay out-of-pocket is limited by federal mandate.

In addition to trying to increase those with adequate insurance, Medicaid, similarly to the ACA, are working to reduce those actions taken by insurance companies, healthcare providers, and patient consumers that add to the increasing medical care costs. For instance, going to the emergency room for non-emergency purposes is one thing directly addressed by Medicaid.

For example, Beverly would go to the local ER when her Type II Diabetes caused her foot pain. She did not have a primary care physician, and the local free clinic often had a months-long wait for an appointment. Those with low income and no insurance who cannot afford to go to the doctor for what many people see as a minor health issue, such as a cold, have few options for care. Since emergency rooms cannot turn anyone away, an individual can go to the ER for antibiotics or other treatment and care that should be done in a physician’s office. Medicaid charges premiums for non-emergency use of emergency rooms as a means of trying to curb this behavior and help lower costs for care overall.

8.6.4 Older Americans Act

As the population is growing now and deficits in programming and policies are becoming more apparent, recognition of struggles faced by older Americans was the impetus for creating the Older American Act of 1965, which was designed to support a wide range of social services and programs for individuals aged 60 years or older. According to the Administration on Aging (n.d.a):

Congress passed the Older Americans Act (OAA) in 1965 in response to concern by policymakers about a lack of community social services for older persons. The original legislation established authority for grants to States for community planning and social service research and development projects, and personnel training in the field of aging. The law also established the Administration on Aging (AoA) to administer the newly created grant programs and to serve as the Federal focal point on matters concerning older persons. (para. 1)

Basically, the AoA, in line with the provisions of the OAA, provides services and programs focused on alleviating societal woes of older Americans that are regulated and overseen by state governmental bodies. These services and programs are offered through various social service and healthcare agencies, both public and private non-for profit. While the AoA does the most to meet need, with programming and information dissemination, there are other governmental programs and policies that can be utilized by the older population as well.

8.6.5 Advocacy Groups

Advocacy groups focus on supporting older adults by working to get issues in the public eye and addressed by legal or other means. They often work with legislators at the state and federal level to advocate for programs that support seniors. These issues may include housing, medical care, food insecurity, elder abuse, and poverty. They provide a helpful “lever” to keep attention on issues that older adults face.

In the US, by far the biggest and most powerful advocacy group for seniors is AARP (formerly the American Association of Retired Persons). AARP lobbies both state and federal congresses for issues that impact seniors, such as prescription drug costs, dental, vision, and hearing coverage, support for informal caregivers, affordable housing, and age-friendly communities. AARP has been criticized in the past for focusing on issues that affect more affluent and white elders, but has worked more recently to broaden their scope and their message.

Another important advocacy group is the Gray Panthers, a network of local chapters that focus on an intergenerational approach to fighting ageism and advocating for other social justice issues that impact older adults

8.6.6 References

Austin, A., & Wetle, V. (2012). The United States health care system: Combining business, health, and delivery (2nd Ed.). Pearson Education, Inc.

Kongstvedt, P. R. (2009). Managed care: What it is and how it works (3 rd Ed.). Jones and Bartlett Publishers.

Kronenfeld, J. J. (2011). Medicare. Greenwood.