Improving the Medicare Savings Programs Would Help Low-Income Seniors Cope With Higher Medical Expenses
End Notes
[1] The typical non-elderly adult with income between 100 percent and 150 percent of the poverty line spent 3.8 percent of his or her income on health care. Katherine Desmond et al., “The Burden of Out-of-Pocket Health Spending Among Older Versus Younger Adults: Analysis from the Consumer Expenditure Survey, 1998-2003,” Kaiser Family Foundation, September 2007. The AARP Public Policy Institute has reported starker results. It found that in 2003, Medicare beneficiaries age 65 and older spent an average of 22 percent of their income on out-of-pocket medical expenses. Again, low-income seniors faced the largest financial burdens: seniors with incomes between 135 percent and 200 percent spent 28 percent of their income on health care, on average, while seniors below 135 percent of the poverty line spent 33 percent. Craig Caplan and Normandy Brangan, “Out-of-Pocket Spending on Health Care by Medicare Beneficiaries Age 65 and Older in 2003,” AARP Public Policy Institute, September 2004.
[2] Kaiser Family Foundation, op cit.
[3] Several states have used their flexibility under Medicaid to increase these limits. The Medicare Savings Programs are technically part of Medicaid.
[4] Jack Ebeler, Paul Van de Water, and Cyanne Demchak, “Improving the Medicare Savings Programs,” National Academy of Social Insurance, June 2006.
[5] Alex Federman, Bruce Vladeck, and Albert Siu, “Avoidance of Health Care Services Because of Cost: Impact of the Medicare Savings Program,” Health Affairs, January/February 2005.
[6] This estimate of QMB participation does not include the so-called “QMB-plus” Medicare beneficiaries, who are enrolled in full Medicaid and thus are readily connected to QMB. Participation by this population in QMB is estimated to be very high.
[7] Congressional Budget Office, “A Detailed Description of CBO’s Cost Estimate for the Medicare Prescription Drug Benefit,” July 2004.
[8] Medicare Payment Advisory Commission, “Report to the Congress: Medicare Payment Policy,” March 2008.
[9] Medicare Payment Advisory Commission, op cit. The National Academy of Social Insurance has made similar recommendations. See Ebeler, Van de Water, and Demchak, op cit. A number of the NASI recommendations were included in a version of SCHIP reauthorization legislation (H.R. 3162) that the House passed in 2007.
[10] To qualify for the LIS, beneficiaries must have incomes below 150 percent of the poverty line and assets of no more than $11,990 for individuals and $23,970 for couples in 2008. Individuals with incomes below 135 percent of the poverty line and assets of less than $7,790 for individuals and $12,440 for couples receive greater assistance.
[11] Technically, Maine modified the MSP eligibility criteria to make them even more generous than those applied by the LIS but because MSP enrollees are deemed eligible for the LIS, the eligibility criteria for the MSPs and the LIS were effectively aligned. Medicare Payment Advisory Commission, op cit.
[12] Medicare Payment Advisory Commission, “Report to the Congress: Medicare Payment Policy,” op cit.
[13] Brian Biles, Lauren Hersh Nicholas, Barbara Cooper, Emily Adrion and Stuart Guterman, “The Cost of Privatization: Extra Payments to Medicare Advantage Plans— Updated and Revised,” The Commonwealth Fund, November 2006; Brian Biles and Emily Adrion, “The Cost of Privatization: Extra Payments to Medicare Advantage Plans; Updated Tables for 2007,” George Washington University, May 1, 2007; and Brian Biles, Emily Adrion and Stuart Guterman, “The Cost of Privatization: Extra Payments to Medicare Advantage Plans in 2008,” (forthcoming 2008).
[14] Mark Miller, “The Medicare Advantage Program and MedPAC Recommendations,” Testimony before the House Budget Committee,” Medicare Payment Advisory Commission, June 28, 2007 and Glenn Hackbarth, Oral Testimony before the Senate Finance Committee, April 11, 2007. See also Medicare Payment Advisory Commission, op cit.
[15] Glenn Hackbarth, “Report to the Congress: Medicare Payment Policy,” Testimony before the Health Subcommittee of the House Ways and Means Committee, March 11, 2008
[16] Medicare Rights Center, “Too Good to Be True: The Fine Print in Medicare Private Health Plan Benefits,” April 2007; Brian Biles et al., op cit; Medicare Payment Advisory Commission, “Report to the Congress: Benefit Design and Cost Sharing in Medicare Advantage Plans,” December 2004; Patricia Neuman, “Medicare Advantage: Key Issues and Implications for Beneficiaries,” Testimony before the House Budget Committee, Kaiser Family Foundation, June 28, 2007; and Government Accountability Office, “Medicare Advantage: Increased Spending Relative to Medicare Fee-for-Service May Not Always Reduce Beneficiary Out-of-Pocket Costs,” February 2008.
[17] See Edwin Park and Robert Greenstein, “Low-Income and Minority Beneficiaries Do Not Rely Disproportionately on Medicare Advantage Plans,” Center on Budget and Policy Priorities, Revised April 12, 2007.
[18] Mark Miller, “The Medicare Advantage Program and MedPAC Recommendations,” Testimony before the House Budget Committee,” Medicare Payment Advisory Commission, June 28, 2007 and Hackbarth, op cit.
[19] Government Accountability Office, op cit.
[20] Congressional Budget Office, “Preliminary CBO Estimates of Policies Capping the Medicare Advantage Benchmarks,” April 15, 2008.
[21] See Fawn Johnson, “Stark, Camp Disagree Over Paths to Keep Medicare Solvent,” Congress Daily, April 1, 2008 and BNA Health Care Policy Daily, “Cutting Managed Care Pay Would Prolong Medicare Trust Fund Solvency, Actuary Says,” April 2, 2008.