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Overview of Health Care Coverage for Older People

By

Roger I. Schreck

, MD, Merck Manual

Last full review/revision Dec 2020| Content last modified Dec 2020
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Current details regarding funding and availability of medical care in the United States remain unsettled. The reader is referred to the Centers for Medicare & Medicaid Services and The Henry J. Kaiser Family Foundation for recent information.

Dealing with the costs of a serious or chronic disorder can be as distressing as dealing with the disorder itself. The costs are often beyond the personal resources of most people. For older people in the United States, most health care expenses are paid for by the following:

In addition, many states offer health-related benefits and programs for older people, such as subsidies for transportation, housing, utilities, telephone, and food expenses, as well as help at home and nutrition services.

Understanding how Medicare, Medicaid, or other government programs work is complicated. What is completely paid for, what is partly paid for, who pays for how much of what, and how the payments are arranged can be difficult to understand. The programs change frequently, and for Medicaid, the regulations vary from state to state. But part of the problem is the complexity and fragmented nature of the U.S. health care system and of the payment system for health care.

  • Fee-for-service: Health care practitioners and institutions are paid for each hospital stay, each visit to a practitioner, each test, and each treatment.

  • Capitation: Practitioners and institutions are paid a fixed amount each month for each person regardless of how many or few visits, tests, or procedures the person has.

Some health care plans are managed. Managed care simply means that a health care plan gives directions to health care practitioners and institutions about what care should be provided and when. These directions are intended to help ensure better, more consistent care and to control costs. Managed care can include health maintenance organizations (HMOs), preferred provider organizations (PPOs), point-of-service (POS) plans, or a combination.

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