The State of Coverage to Supplement Medicare in Massachusetts
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1 The State of Coverage to Supplement Medicare in Massachusetts Nancy Turnbull SEPTEMBER 24, 2015
2 Medicare covers nearly 1.2 million residents of Massachusetts. ~900,000 people age 65 or older ~300,000 people under age 65 with disabilities 2
3 Medicare has many gaps. Premium Deductible Copayments/ Coinsurance Benefit Limits Other gaps PART A PART B PART D For some, up to $407/month $1,260 per benefit period (can have >1 per year) $315-$630 per day for hospital 100 days/snf 190 psychiatric hospital days /lifetime $105/month (and more for those with higher income) $147 per year $320/year 20% for physician and other medical (including diagnostic) Dental, vision, long-term care services Depends on plan selected 25% up to $2,960 in total drug costs 45% / 65% between $2,960 and $6,680 3
4 Coverage to supplement Medicare is an important source of financial protection. Number of Medicare Beneficiaries in Massachusetts, , , , ,000? Medigap Plans Medicare Advantage Plans MassHealth GIC/Federal Retirees Other or None TYPE OF SUPPLEMENTAL COVERAGE 4
5 Prescription drug coverage is vital, too. Number of Medicare Beneficiaries in Massachusetts, , , ,000 Stand-alone PDP Medicare Advantage with Rx 7,000 Medigap with Rx 111,000 GIC/Federal Retirees TYPE OF SUPPLEMENTAL COVERAGE MassHealth? 0 Other or None 5
6 Lots of Private Plan Choices Medigap Products Medicare Advantage Products Stand-alone Prescription Drug Plans 6
7 A variety of other public programs provide additional coverage and financial protection. MEDICARE SAVINGS PROGRAMS EXTRA HELP HEALTH SAFETY NET 7
8 Issue #1: Lack of Health Insurance ~50,000+ elders each year have a period without coverage 45,000 have a spell without coverage 6,000 had no coverage for the entire year Some ineligible for premium-free Medicare Part A Medicare Part A premium can be $400/month Workers more likely to be ineligible for Medicare: Domestic workers, seasonal workers, and migrant workers, some federal, state, and local government retirees 8
9 Issue #2: Supplemental coverage is expensive, particularly relative to average income. Distribution of Members by Monthly Premium: Medicare Advantage Direct Pay Members with Prescription Drug Coverage (n=175,000 people) December 2014 February % 47% 10% 28% 27% 22% 12% 13% $0 $1 to $69 $70 to 139 $140+ MONTHLY PREMIUM 9
10 Issue #2: Supplemental coverage is expensive, particularly relative to average income. Premiums and Out-of-Pocket Spending Limit Annual Amount Medicare Part B Premium $1,259 As a percent of Average Social Security Benefit in Massachusetts ($16,000) Medicare Advantage Premium (most popular product) $2,546 Total Premiums $3,808 24% Plus: Total out-of-pocket spending limit (for covered services) $3,400 Total Premiums and Out-of-pocket $7,208 45% 10
11 Issue #3: Premiums for the most popular private plans are increasing rapidly and much faster than Social Security benefits. Type of Plan Range of Premium Increase: 2009 to 2015 Medigap Plans -1% to +47% Medicare Advantage Plans -27% to +214% Prescription Drug Plans -7% to +36% Social Security Benefits COLA increase +8.7% 11
12 Issue #4: Private coverage and public programs are complicated and fragmented, making them hard to understand and navigate. Lots of different private plans choices Different rules for different public programs Income and asset amounts vary Application process can be complex Different agencies responsible for different programs Many people eligible but not enrolled Less than one-third of eligibles in U.S. enrolled in the Medicare Savings Programs 12
13 Issue #5: Elders may have less access to affordable health coverage than non-elders with the same income. MassHealth (for community-residing individuals) Connector Care (for those without access to affordable ESI) PEOPLE AGE 65 OR OLDER ADULTS UNDER AGE % FPL plus asset test Not eligible People with disabilities (ages 0-64) Former foster care children up to age 26 Individuals with breast or cervical cancer Pregnant women and persons with HIV Adults without one of the above conditions No income limit; those with higher incomes pay premiums No income limit 250% FPL 200% FPL 133% FPL Up to 300% FPL; sliding scale premiums based on income. (Up to 400% FPL for federal tax credits) 13
14 Issue #6: Little ongoing publicly available analysis and synthesis about this important part of the health insurance market Dozens (hundreds?) of reports on costs, coverage, access, satisfaction with health coverage for people under age 65 in last decade 14
15 IN CONTRAST, Major public reports on coverage to supplement Medicare, affordability, access to services and care among Medicare beneficiaries in Massachusetts 15
16 Questions? 16
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