The Medicare Cliff: Washington State Is Failing Seniors and People with Disabilities

Did you know that when low-income seniors and people with disabilities in Washington become eligible for Medicare, many lose access to affordable, comprehensive healthcare?

Before adults qualify for Medicare, they may qualify for Affordable Care Act programs, including the Medicaid Expansion and subsidized Health Benefit Exchange health insurance plans. The ACA Medicaid program allows income up to 138% of the federal poverty level (FPL) and covers a wide range of healthcare with no cost to beneficiaries. People with incomes up to 400% of FPL get significant subsidies for Exchange health insurance plans, and pandemic relief legislation capped premium costs for all income levels. However, these programs are only for adults without Medicare. People with Medicare must have MUCH lower income and limited resources to get Medicaid or financial assistance for premiums and cost-sharing. Washington pushes vulnerable people off the “Medicare cliff” when they no longer have access to financial assistance programs they had before becoming eligible for Medicare.

As a result of this inequity, half of Medicare enrollees with income under 200% FPL pay 27% or more of their income for medical costs.

Washington is one of only 16 states that have taken no action, keeping eligibility standards at the lowest level allowed by federal law. NoHLA’s new report explains how Washington State can protect older adults and people with disabilities transitioning to Medicare by keeping care more affordable and covering services they need.

NoHLA is grateful to the Pacific Hospital Preservation and Development Authority (PHPDA) for the grant funding that allowed us to produce this report.

NoHLA Blog