The center found that a large majority of participants wanted to add or expand benefits for services such as long-term care, dental, vision, hearing, long-term mental health counseling and transportation. Most did not want to eliminate benefits. But most backed some limitations on coverage, including allowing coverage of only palliative care but not curative treatments for people with long-standing incurable illnesses who are growing more frail, and eliminating coverage of ICU services for dying patients.
In addition, most participants supported requiring all beneficiaries to use narrower provider networks and making those with incomes of more than $85,000 a year pay higher Part B premiums. In addition, a large majority said that for patients with chronic conditions such as heart disease, Medicare should pay no more than half the cost of treatments whose effectiveness is questionable or that are more expensive than equally effective alternatives. For beneficiaries facing a sudden devastating illness or injury, slightly more than half wanted to cover “long shot” treatments when conventional treatment fails.
After taking part in the MedCHAT discussion process, significantly more participants said Medicare needs significant changes—from 54% at the start to 75% by the end. The share of participants who said the program needs a total overhaul hardly budged, moving from 9% to 10%.
The center concluded that participants found the goal of greater fiscal stability for Medicare compelling, “but not as compelling as being able to create a better benefits package.”
These findings may offer something for policymakers to think about as they debate proposals such as raising the Medicare eligibility age and reforming Medicare cost-sharing while they try to sidestep benefit enhancements such as long-term-care coverage as well as anything that could be called a death panel.
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