Vermonters on Medicare are struggling with high costs. A bill before the legislature would help.

“I am paying more for premiums for Medicare and Supplemental coverage than I was paying under Vermont Health Connect. I expected it to be the opposite.” 

— Vermonter with Medicare

Each year, the Office of the Health Care Advocate (HCA) hears from hundreds of Vermonters who have Medicare and are struggling to afford the health services that they need. Twin bills before the legislature (H.118 / S.61) would help many of those Vermonters by raising the income limits for Vermont’s Medicare Savings Programs.

Most people think that when they go onto Medicare, their out-of-pocket costs for health care will go down. But between premiums, deductibles, and 20% cost sharing, many Vermonters find that their costs actually go up significantly. Additionally, many low-income Vermonters are shocked to learn that they no longer qualify for the state and federal programs that helped them afford their health care costs before going onto Medicare. This is because when you turn 65 or qualify for Medicare due to a disability, the eligibility rules change, and many Vermonters get locked out of the state and federal programs that would otherwise help.

This is hard for anyone who has a low or even moderate income in Vermont and transitions onto Medicare. Wages and social security have not kept up with the cost of basic needs like food, shelter, transportation, and health care. But it is especially hard for Vermonters who have been at an economic disadvantage for much of their lives.

Change the Story’s 2019 report on “Work, Women and Wages in Vermont” describes the cumulative effect that a lifetime of lower wages and exiting the workforce more often or early for child or elder caretaking responsibilities has on women. The authors note that “Women’s lower earnings result in reduced social security benefits — 59% of what Vermont men receive.” This means “44% of Vermont women over 65 do not have enough income to make ends meet.” In a recent Medicare affordability survey conducted by the HCA, one older woman reflected on her transition to Medicare: “Costs went up — I now avoid extra doctor visits as I have no idea what is or isn’t covered and every visit seems to include a copay.”

Vermonters with one or more disabilities are also at a significant economic disadvantage, earning significantly less than those without a disability. In their “2019 Demographics: Vermont Adults with a Disability” bulletin, the Vermont Department of Health concluded: “Vermonters with disabilities experience unequal access to economic opportunities leading to poorer health outcomes, compared to Vermonters without disabilities.” 

Over the years, health policy reforms like the Affordable Care Act have expanded coverage options for people who are under age 65 and do not have a disability. These reforms have ignored seniors and people with disabilities resulting in an inequitable system of financial support, leaving them with less help at a time when many are transitioning to a fixed income and are most in need. Reflecting on the loss of financial support, a Vermont woman described the situation for herself and her husband, both on Medicare: 

“After we pay everything, we have nothing left … we weren’t doing that great before but at least we were surviving. Now we aren’t going to be able to survive with them taking all that money from us. No one seems to want to do anything.”

It doesn’t have to be this way. Governor Scott and the Vermont Legislature can increase the income limits for Vermont’s Medicare Savings Program, following in the footsteps of other states that have taken action, including Massachusetts, New York, Connecticut and Maine. The HCA has promoted the introduction of state legislation (H.118 / S.61) and is encouraged by a growing coalition of supporters, including the Area Agencies on Aging, AARP Vermont, Disability Rights Vermont, the Vermont Alzheimer’s Association, the Vermont Workers’ Center, the Vermont-National Education Association, the Community of Vermont Elders (COVE), the Bi-State Primary Care Association, Vermont Association of Hospitals and Health Systems, and Blue Cross Blue Shield of Vermont.

Vermonters with Medicare deserve better. By expanding access to the Medicare Savings Program, the state could enable more low income and disabled Vermonters to afford the care that they need and get it at the right time. Since delaying care can lead to more costly complications and emergencies down the line, this policy change could lead to less suffering on the part of individuals and lower costs for the overall health system. 

Additionally, it could help address the structural inequalities that disproportionately affect older women and people with disabilities. The proposed state legislation to expand the Medicare Savings Program (H.118 / S.61) provides an opportunity to advance meaningful health care reform that has already been tried and tested in other states. We urge all legislators and the Governor to support its passage in the upcoming legislative session.

Michael Fisher

Lincoln