Reforming Medicare s benefit design. Julie Lee, Scott Harrison, and Joan Sokolovsky March 8, 2012
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1 Reforming Medicare s benefit design Julie Lee, Scott Harrison, and Joan Sokolovsky March 8, 2012
2 Outline of today s presentation Policy objectives Key design issues Illustrative benefit package With and without a surcharge on supplemental insurance Budgetary and distributional effects Chairman s draft recommendation 2
3 Objectives for reforming Medicare s benefit design Reduce beneficiaries exposure to risk of unexpectedly high out-of-pocket spending Require some cost sharing to discourage use of lower-value services Be mindful of effects on low-income beneficiaries and those in poor health 3
4 Design issues: cost sharing Out-of-pocket maximum Provides insurance protection against very high Medicare costs Combined deductible for Part A and Part B services Raises issues related to separable participation in Part A and Part B, and different sources of financing for Part A and Part B Copayments for services Allows for degree of variation to create incentives Secretarial authority to vary copayments based on value of services as evidence becomes available over time 4
5 More beneficiaries would benefit from OOP maximum over time Percent of full-year FFS beneficiaries hospitalizations 19% 46% 2+ hospitalizations 7% 26% $5,000+ in annual cost-sharing liability $10,000+ in annual cost-sharing liability 6% 13% 2% 4% Note: Includes beneficiaries who were enrolled in FFS Medicare for 4 full years, from 2006 to Excludes those who had any months of Medicare Advantage enrollment. 5
6 Design issues: budget constraint Overall cost of the benefit design depends on the level of cost sharing of the benefit package Budgetary target for the new package limits design combinations that are feasible There are many different solutions 6
7 Design issues: supplemental insurance Want to create incentives to discourage use of lower-value services Higher cost sharing reduces both effective and ineffective services Within FFS, changing cost sharing may be the only policy tool available Mitigate the effects of first-dollar coverage Regulatory approach Surcharge on supplemental policies 7
8 Illustrative FFS benefit package Design elements Beneficiary-neutral package OOP maximum $5000 A & B deductible $500 Hospital (per stay) Physician PCP/specialist (per visit) Part B drugs Advanced imaging (per study) Outpatient (per visit) SNF (per day) DME Hospice Home health (per episode) $750 $20/$40 20% $100 $100 $80 20% 0% $150* Note: We modeled the $150 copayment considered by the Commission as 5% coinsurance on home health services for simplicity. 8
9 Illustrative benefit: budgetary effects Change in Policy change Medicare program spending in 2009 Illustrative benefit package +1% 20% surcharge on supplemental insurance -1.5% Modeling assumptions 1-year snapshot of relative changes using 2009 data Excludes dual-eligible beneficiaries Specific set of behavior assumptions on use of services On supplemental coverage, simple assumptions of average premiums and no switching among beneficiaries with supplemental coverage No change in medigap premiums Simplifying assumption of 20% on average premiums 3% of beneficiaries with supplemental coverage would drop 9
10 Changes in Medicare OOP spending and premiums under the illustrative benefit package, 2009 Percent of beneficiaries 100% 80% 60% 40% 20% 1% 2% 20% 68% 70% 24% Average OOP change per beneficiary (under benefit changes with surcharge): $220 $240 per year higher $1000+ higher $250-$999 change under $250 lower $250-$999 lower $ % 6% 4% 3% 3% Benefit changes only Benefit changes with surcharge Note: Beneficiaries included in this analysis were enrolled in both Part A and Part B for the full year and not enrolled in private Medicare plans or Medicaid. Source: MedPAC based on data from CMS. 10
11 Other issues Would the new benefit apply to all beneficiaries or new beneficiaries? How would a combined deductible affect beneficiaries enrolled in only Part A? How would the new benefit change Part B premiums? 11
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