Policy Issues in Medicare

1
Policy Issues in Medicare

• Marilyn Moon
• The Urban Institute
• April 7, 2003

2
Share of Health Care Spending Paid by Various
Sources, All Medicare Beneficiaries, 1998
Out-of-Pocket 21.2
Medicare 51.7
Private 12.4
Medicaid 14.6
Source Urban Institute analysis of the 1998
Medicare Current Beneficiary Survey
3
Sources of Supplemental Coverage Among
Non-Institutionalized Medicare Beneficiaries, 1999
Other 2
Medicare HMOs 17
Medicare Only 13
Medicaid 11
Medigap 24
Employer-Sponsored 33
Includes those receiving coverage from other
public programs as well as those in at-risk HMOs
Source Barents Group of KPMG Consultings
analysis of the 1999 MCBS
4
Distribution of Out-of-Pocket Expenditures Among
Elderly Medicare Beneficiaries, 1999
Prescription Drugs 8.6
Supplemental Insurance Premiums
Prescription Drugs 18.1
Other Services 25.5
Other 7.2
Cost-Sharing for Medicare Services 15.6
Part B Premium 25.0
Source Urban Institute analysis of the 1999
MCBS Note Excludes HMO, ESRD, and Facility
beneficiaries
5
Share of Total Drug Expenditures
by Medicare Beneficiaries' Spending Levels
9
8.5
8.3
8.3
7.6
8
6.8
6.8
7
6.5
6.1
6.1
6.0
6
5.5
5.0
4.6
5
4.2
Percentage of Total Expenditures
3.9
3.6
4
3
2.3
2
1
0.0
0
0
0-500
20,000
500-1,000
1,000-1,500
1,500-2,000
2,000-2,500
2,500-3,000
3,000-3,500
3,500-4,000
4,000-4,500
4,500-5,000
5,000-5,500
5,500-6,000
6,000-7,000
7,000-8,000
8,000-10,000
10,000-20,000
Per Capita Drug Expenditures
Source Urban Institute analysis of the 1999 MCBS
6
Medicare and Beneficiary Share of Drug
Expenditures by Level of
Beneficiary Spending, 77 copay
9
8
7
6
5
Percentage of Total Expenditures
4
3
2
1
0
0
0-500
20,000
500-1,000
1,000-1,500
1,500-2,000
2,000-2,500
2,500-3,000
3,000-3,500
3,500-4,000
4,000-4,500
4,500-5,000
5,000-5,500
5,500-6,000
6,000-7,000
7,000-8,000
8,000-10,000
10,000-20,000
Per Capita Drug Expenditures
Government
Individual
Source Urban Institute analysis of the 1999 MCBS
7
Medicare and Beneficiary Share of Drug
Expenditures by Level of
Beneficiary Spending, 25 copay up to 812
9
8
7
6
5
Percentage of Expenditures
4
3
2
1
0
0
0-500
20,000
500-1,000
1,000-1,500
1,500-2,000
2,000-2,500
2,500-3,000
3,000-3,500
3,500-4,000
4,000-4,500
4,500-5,000
5,000-5,500
5,500-6,000
6,000-7,000
7,000-8,000
8,000-10,000
10,000-20,000
Per Capita Drug Expenditures
Government
Individual
Source Urban Institute analysis of the 1999 MCBS
8
Medicare and Beneficiary Share of Drug
Expenditures by Level of
Beneficiary Spending, Stop Loss of 3,462
9
8
7
6
5
Percentage of Total Expenditures
4
3
2
1
0
0
0-500
20,000
500-1,000
1,000-1,500
1,500-2,000
2,000-2,500
2,500-3,000
3,000-3,500
3,500-4,000
4,000-4,500
4,500-5,000
5,000-5,500
5,500-6,000
6,000-7,000
7,000-8,000
8,000-10,000
10,000-20,000
Per Capita Drug Expenditures
Government
Individual
Source Urban Institute analysis of the 1999 MCBS
9
Projected Out-of-Pocket Spending as a Share of
Income Among Cohorts, 2000 and 2025
Source The Urban Institutes 1999 Medicare
Projections Model
10
Medicare Enrollment in HMOs
7
6.3
6.2
5.8
6
5.6
5.6
4.7
5
3.8
4
Enrollment in Millions
3.0
3
2.6
2.3
2.2
2.0
1.8
2
1
0
Jan-90
Jan-91
Jan-92
Jan-93
Jan-94
Jan-95
Jan-96
Jan-97
Jan-98
Jan-99
Jan-00
Jan-01
Jan-02
Note Total Coordinated Care Plans. Source
Health Care Financing Administration
11
Relative Health Status of HMO Enrollees, 1998
Non-HMO Enrollees
HMO Enrollees
89.9
No ADLs
85.2
4.6
3 or More ADL Limitations
8.2
78
Health Excellent, Very Good or
Good
68.9
22
Health Fair or Poor
31.1
Source HCFA/Office of Strategic Planning Data
from MCBS, 1998
12
Includes hospital care, physician an d clinical
services, durable medical equipment, and other
professional services. Source Urban Institute
analysis of National Health Expenditures data
from The Centers for Medicare and Medicaid
Services.