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Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries.
Health Serv Res 1999; 34(1 Pt 2):241-54HS

Abstract

OBJECTIVE

To estimate out-of-pocket health care spending by lower-income Medicare beneficiaries, and to examine spending variations between those who receive Medicaid assistance and those who do not receive such aid. DATA SOURCES AND COLLECTION: 1993 Medicare Current Beneficiary Survey (MCBS) Cost and Use files, supplemented with data from the Bureau of the Census (Current Population Survey); the Congressional Budget Office; the Health Care Financing Administration, Office of the Actuary (National Health Accounts); and the Social Security Administration.

STUDY DESIGN

We analyzed out-of-pocket spending through a Medicare Benefits Simulation model, which projects out-of-pocket health care spending from the 1993 MCBS to 1997. Out-of-pocket health care spending is defined to include Medicare deductibles and coinsurance; premiums for private insurance, Medicare Part B, and Medicare HMOs; payments for non-covered goods and services; and balance billing by physicians. It excludes the costs of home care and nursing facility services, as well as indirect tax payments toward health care financing.

PRINCIPAL FINDINGS

Almost 60 percent of beneficiaries with incomes below the poverty level did not receive Medicaid assistance in 1997. We estimate that these beneficiaries spent, on average, about half their income out-of-pocket for health care, whether they were enrolled in a Medicare HMO or in the traditional fee-for-service program. The 75 percent of beneficiaries with incomes between 100 and 125 percent of the poverty level who were not enrolled in Medicaid spent an estimated 30 percent of their income out-of-pocket on health care if they were in the traditional program and about 23 percent of their income if they were enrolled in a Medicare HMO. Average out-of-pocket spending among fee-for-service beneficiaries varied depending on whether beneficiaries had Medigap policies, employer-provided supplemental insurance, or no supplemental coverage. Those without supplemental coverage spent more on health care goods and services, but spent less than the other groups on prescription drugs and dental care-services not covered by Medicare.

CONCLUSIONS

While Medicaid provides substantial protection for some lower-income Medicare beneficiaries, out-of-pocket health care spending continues to be a substantial burden for most of this population. Medicare reform discussions that focus on shifting more costs to beneficiaries should take into account the dramatic costs of health care already faced by this vulnerable population.

Authors+Show Affiliations

Public Policy Institute, American Association of Retired Persons, Washington, DC 20049, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10199672

Citation

Gross, D J., et al. "Out-of-pocket Health Spending By Poor and Near-poor Elderly Medicare Beneficiaries." Health Services Research, vol. 34, no. 1 Pt 2, 1999, pp. 241-54.
Gross DJ, Alecxih L, Gibson MJ, et al. Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries. Health Serv Res. 1999;34(1 Pt 2):241-54.
Gross, D. J., Alecxih, L., Gibson, M. J., Corea, J., Caplan, C., & Brangan, N. (1999). Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries. Health Services Research, 34(1 Pt 2), pp. 241-54.
Gross DJ, et al. Out-of-pocket Health Spending By Poor and Near-poor Elderly Medicare Beneficiaries. Health Serv Res. 1999;34(1 Pt 2):241-54. PubMed PMID: 10199672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries. AU - Gross,D J, AU - Alecxih,L, AU - Gibson,M J, AU - Corea,J, AU - Caplan,C, AU - Brangan,N, PY - 1999/4/13/pubmed PY - 1999/4/13/medline PY - 1999/4/13/entrez SP - 241 EP - 54 JF - Health services research JO - Health Serv Res VL - 34 IS - 1 Pt 2 N2 - OBJECTIVE: To estimate out-of-pocket health care spending by lower-income Medicare beneficiaries, and to examine spending variations between those who receive Medicaid assistance and those who do not receive such aid. DATA SOURCES AND COLLECTION: 1993 Medicare Current Beneficiary Survey (MCBS) Cost and Use files, supplemented with data from the Bureau of the Census (Current Population Survey); the Congressional Budget Office; the Health Care Financing Administration, Office of the Actuary (National Health Accounts); and the Social Security Administration. STUDY DESIGN: We analyzed out-of-pocket spending through a Medicare Benefits Simulation model, which projects out-of-pocket health care spending from the 1993 MCBS to 1997. Out-of-pocket health care spending is defined to include Medicare deductibles and coinsurance; premiums for private insurance, Medicare Part B, and Medicare HMOs; payments for non-covered goods and services; and balance billing by physicians. It excludes the costs of home care and nursing facility services, as well as indirect tax payments toward health care financing. PRINCIPAL FINDINGS: Almost 60 percent of beneficiaries with incomes below the poverty level did not receive Medicaid assistance in 1997. We estimate that these beneficiaries spent, on average, about half their income out-of-pocket for health care, whether they were enrolled in a Medicare HMO or in the traditional fee-for-service program. The 75 percent of beneficiaries with incomes between 100 and 125 percent of the poverty level who were not enrolled in Medicaid spent an estimated 30 percent of their income out-of-pocket on health care if they were in the traditional program and about 23 percent of their income if they were enrolled in a Medicare HMO. Average out-of-pocket spending among fee-for-service beneficiaries varied depending on whether beneficiaries had Medigap policies, employer-provided supplemental insurance, or no supplemental coverage. Those without supplemental coverage spent more on health care goods and services, but spent less than the other groups on prescription drugs and dental care-services not covered by Medicare. CONCLUSIONS: While Medicaid provides substantial protection for some lower-income Medicare beneficiaries, out-of-pocket health care spending continues to be a substantial burden for most of this population. Medicare reform discussions that focus on shifting more costs to beneficiaries should take into account the dramatic costs of health care already faced by this vulnerable population. SN - 0017-9124 UR - https://www.unboundmedicine.com/medline/citation/10199672/Out_of_pocket_health_spending_by_poor_and_near_poor_elderly_Medicare_beneficiaries_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/10199672/ DB - PRIME DP - Unbound Medicine ER -