What If I Don’t Want Medicare?
Even if you’re eligible, you don’t have to use Medicare. If you or your spouse are still working full time at 65 and insured by an employer’s group plan, you can stay on that policy. “Typically, group insurance prescription drug coverage is better,” says Suzy Alberts, a health underwriter in Detroit. Medicare plans include copayments and even a coverage gap for drug costs, says Alberts. “Some drugs for arthritis, such as Enbrel, are very expensive. So people need to understand their prescription drug plan. Make sure you get all the details.”

However, Cathy Daugherty, a health underwriter in Irvine, Calif., says Medicare laws could change depending on election outcomes in the future. “I highly recommend that anyone turning 65 get on Medicare now,” she says. “Some people put this off for different reasons, but there could be some lesser benefits in the future. Once you lock in your benefits, you are set.”

Daugherty used to advise employed people 65 or over stay on their company policies, but now she counsels them to get on Medicare. “My gut tells me changes are coming. The benefits are good now, so if you get on Medicare today, you get to keep those benefits.”

What Is the Future of Medicare?
The 2010 passage of the Patient Protection and Affordable Care Act (ACA) offered Medicare participants extended coverage, discounts and fraud protections. In 2011, Medicare coverage expanded under the ACA to include a yearly wellness visit and many preventive services, like bone mass measurement or cervical cancer screening, for no cost to those on traditional Medicare. Learn more about Affordable Care Act and Medicare benefits.

The ACA aims to cut wasteful spending that passes costs to Medicare members. For example, starting in 2014, Medicare Advantage plans must follow stricter policies to cut down on administrative costs or company profits. However, some experts fear that if providers must reduce these costs, they may slash benefits like vision or dental care to save their profits in the future.

Skepticism about the long-term impact of the ACA includes worries about cuts to the federal budget to finance the changes. According to a 2011 report in Generations: The Journal of the American Society on Aging, these cuts totaled more than a half-trillion dollars of cuts to Medicare funding. Cuts stoke fears that expanded coverage requirements of ACA will gut Medicare in the future. The ACA extends the funding of Medicare through 2029, but some experts fear that the source of the funding – reductions in government payment rates to Medicare providers like hospitals – may encourage some institutions to withdraw from participation in Medicare altogether. If that occurs, seniors and people with serious disabilities would be denied care.  Others worry that if Medicare cannot sustain itself financially, these individuals will be without coverage. The debate is complex and ongoing.

To get more information on your options regarding Medicare, here are some helpful resources: