You may have been hearing a lot on the news lately about Medicare expansion states and might have a lot of questions about it, like which states are expanding Medicare? When is it happening? And how will it affect you?

It’s a bit of a confusing subject, but it’s not all that complicated once you sit down and really look at it. Below, we’ll go into more detail about Medicare expansion states and what they mean for you.

Explaining Medicare Expansion

Recently, the Biden Administration has been trying to pass a comprehensive bill called the Build Back Better plan. That plan had provisions in it for expanding certain Medicare benefits — sadly, those benefits were removed from the bill in order to get more representatives to vote for its approval.

Therefore, we won’t see any expansion of Medicare benefits anytime soon unless something changes.

Differences Between Medicare Expansion and Medicaid Expansion

One reason so many people express confusion about Medicare expansion is that they may think it is Medicaid expansion. The truth is that there is no state-by-state Medicare expansion; the Medicare program operates on a federal level, and only makes state-by-state changes in extremely rare situations. Medicaid, on the other hand, is handled on a state-by-state basis and managed by local laws and legislatures.

Furthermore, Medicaid expansion states are operating based on an individual’s income, not their age. The reason some states are pushing Medicaid expansion is to prevent low-income individuals and families from falling into the coverage gap for people who don’t make enough money to qualify for health insurance through the ACA but make too much money to qualify for Medicaid health insurance.

If Medicare expansion is ever ratified, it will most likely happen in all 50 states at the same time.

Areas Where Medicare Expansion Could Be Helpful

The main areas where Medicare expansion could be the most useful for beneficiaries include:

  • Vision coverage and preventative care
  • Dental coverage and preventative care
  • Hearing coverage and preventative care

Giving the government the legal ability to negotiate prescription drug prices and keep costs down for Medicare recipients who need prescription medication to live and maintain a higher quality of life.

Lowering the qualifying age from 65 to 60 years of age in order to enroll in Medicare Parts A and B

Expanding benefits so that Medicare supplement insurance (like Medigap or Medicare Advantage) is no longer as necessary as they currently are.

Critics of Medicare expansion claim that extending simple benefits like vision and dental or giving the government the clout it needs to negotiate drug prices would somehow bankrupt the system. But vision and dental stand to receive funding from elsewhere.

Sadly, that trust fund is rapidly depleting. But since vision and dental would be paid for under your Part B benefits — which are funded through a completely separate program — and since negotiating prescription drug prices would bring costs down for everybody, this expansion could actually help slow down the depletion of the Medicare trust fund and keep it solvent for a little while longer.

The Current State of Medicare Expansion

Right now, Medicare expansion is still up in the air. The Build Back Better legislation from November 2021 did not include any of the provisions which Medicare expansion advocates were asking for. However, Medicare expansion popularity is only gaining momentum.

The upcoming primary elections in 2022 will likely decide whether or not Medicare expansion is possible in the near future or whether Medicare recipients will have to wait several more years before their government revisits the idea.

FAQs

When will Medicare expand in my state?

Medicare does not expand on a state-by-state basis, but rather on a federal level in all states at the same time. The most recent legislation proposing Medicare expansion in 2021 did not pass. There has not been new legislation for Medicare expansion since.

What is a Medicare expansion?

An expansion of benefits and coverage includes lowering the qualification age to 60 instead of 65, lower prescription drug prices, dental, vision, hearing, and other benefits to help make healthcare for retired Americans more affordable and comprehensive.

When will the Medicare eligibility age be lowered?

Nobody knows. There was legislation in the Build Back Better Act which was supposed to lower the age threshold, but the provision was removed at the last minute. Future legislation, however, may succeed in the near future.

Which Medicare recipients will be eligible for expanded Medicare benefits?

That depends on the legislation which may or may not pass in the future. But if recent attempts to expand medicare become successful at a later date, beneficiaries age 60 and older will qualify for Original Medicare, dental, hearing, and vision care in addition to hospital and outpatient coverage.

Getting Help With Medicare Benefits Right Now

Until Medicare expansion passes in your state, you’re going to have to wait until the year in which you turn 65 in order to qualify (unless you have certain types of health issues, like ESRD). Regardless, we want to be there for you.

Looking for a Medicare Supplement plan once you’re eligible can cover the gaps between your actual health needs and what Original Medicare provides for.

Reach out to our Medicare licensed insurance experts today so that we can make the process as easy and expedient for you as humanly possible.

Give us a call today. Or use our convenient online rate form to receive the best prices on plans in your area.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.