Annual costs for Medicare, already at $560 billion in 2010, are expected to skyrocket in the coming decades along with enrollment. Health care experts agree that costs to consumers are likely to go up, regardless of how the program is changed.
In a basic way, says Marilyn Moon, Medicare expert for the American Institutes for Research, the choice for voters boils down to whether they think the federal government or private insurance would do a better job running Medicare over the long haul.
What do the candidates propose?
The Obama plan hinges on reforms already taking effect through the Affordable Care Act. Provisions that seniors have already seen include free preventive care and the gradual closing of the so-called "doughnut hole" in Part D prescription drug coverage.
Over time, higher-income retirees would pay higher monthly premiums for Medicare.
The projected savings come through decreased funding to Medicare Advantage plans, the private supplement program that led to higher costs, as well as reductions in the rate of reimbursement to hospitals and medical equipment supply companies.
The Congressional Budget Office estimates the savings at $716 billion over the next 10 years. Proponents emphasize that the law does not call for direct cuts to recipients' benefits or doctors' fees.
The Romney plan involves immediate repeal of the Affordable Care Act, including the provisions that already benefit Medicare recipients.
For older adults as well as people nearing retirement, the system would not change.
For people who are not yet age 55, a new premium selection system would provide them a fixed federal payment to buy either private insurance comparable to today's Medicare coverage or a government plan based on Medicare.
The projected savings would come from competition among private insurers, according to www. mittromney.com, and lower-income older adults would receive higher levels of support.