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The Henry J. Kaiser Family Foundation

Adding an Out-of-Pocket Spending Maximum to Medicare: Implementation Issues and Challenges

In an effort to simplify Medicare’s cost-sharing requirements, provide beneficiaries with catastrophic protection, and achieve program savings, some have proposed to restructure Medicare’s benefit design. Several recent proposals would create a unified deductible for Medicare Parts A and B, simplify cost-sharing requirements above the deductible, and add an annual limit on beneficiary out-of-pocket spending—a benefit feature typical of larger employer plans, but lacking in traditional Medicare. This issue brief describes the options for adding an out-of-pocket spending limit to Medicare and examines the operational issues that could arise in implementing both a uniform and an income-based out-of-pocket spending limit. Because the implementation of an income-related out-of-pocket maximum would pose somewhat greater complexity for Medicare, the operational issues associated with this approach are discussed in greater detail.

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The Henry J. Kaiser Family Foundation

Testimony: Income Security and the Elderly: Securing Gains Made in the War on Poverty

Senior Vice President Patricia Neuman testified before the U.S. Senate Special Committee on Aging as part of its hearing entitled Income Security and the Elderly: Securing Gains Made in the War on Poverty. As part of her testimony, she presented segments from a Foundation-produced video that highlights what it means to be old and poor in our country.

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Old and Poor: America's Forgotten

Old and Poor: America’s Forgotten

While the Census Bureau’s official poverty measure shows 9 percent of seniors nationally live in poverty, the share climbs to about one in seven seniors (15 percent) under the Bureau’s alternative Supplemental Poverty Measure, which takes into account out-of-pocket health expenses and geographic differences in the cost of living. Produced by the Kaiser Family Foundation, Old and Poor: America’s Forgotten provides a portrait of seniors who are living in poverty, in both urban and rural areas across the United States.

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The Henry J. Kaiser Family Foundation

Summary of Medicare Provisions in the President’s Budget for Fiscal Year 2015

On March 4, 2014, the Office of Management and Budget released President Obama’s budget for fiscal year (FY) 2015, which includes provisions related to federal spending and revenues, including Medicare savings. The President’s budget would use federal savings and revenues to reduce the federal debt and replace sequestration of Medicare and other federal programs for 2015 through 2024. This brief summarizes the Medicare provisions included in the President’s budget proposal for FY 2015.

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The Henry J. Kaiser Family Foundation

A State-by-State Snapshot of Poverty Among Seniors: Findings From Analysis of the Supplemental Poverty Measure

This brief analyzes poverty rates among seniors in each of the 50 states under two different Census Bureau measures of poverty: the official poverty measure and an alternative supplemental poverty measure, which takes into account health care and housing costs among other factors.

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The Henry J. Kaiser Family Foundation

An Analysis of the Share of Medicare Beneficiaries Who Would Benefit from an Annual Out-of-Pocket Maximum under Traditional Medicare Over Multiple Years

This analysis examines the share of Medicare beneficiaries who would be helped over time if the program were to add a limit on out-of-pocket spending to traditional Medicare. This analysis was conducted jointly with the Medicare Payment Advisory Commission (MedPAC) in response to a request made during a Feb. 26, 2013 hearing of the House Ways and Means’ Subcommittee on Health.

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The Henry J. Kaiser Family Foundation

Health Care on a Budget: The Financial Burden of Health Spending by Medicare Households

The Medicare program offers health and financial protection to nearly 50 million seniors and younger people with disabilities, though many beneficiaries still face significant out-of-pocket expenses. This analysis examines how much Medicare households spend on health-related expenses compared to other spending priorities and compared to non-Medicare households, the extent to which Medicare households’ health spending as a share of household budgets varies by age and poverty level, and changes in Medicare households’ health spending over time.

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The Henry J. Kaiser Family Foundation

How Much Skin in the Game is Enough? The Financial Burden of Health Spending for People on Medicare

How Much ” Skin in the Game ” is Enough? The Financial Burden of Health Spending for People on Medicare Medicare extends health security and financial protection to seniors and younger people with disabilities. However, premiums, relatively high cost-sharing requirements, and gaps in the benefit package result in some beneficiaries…

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The Henry J. Kaiser Family Foundation

Projecting Income and Assets: What Might the Future Hold for the Next Generation of Medicare Beneficiaries?

As national attention turns to the federal deficit, some policymakers have proposed reforms to Medicare, Medicaid and Social Security that could have significant implications for current and future generations of seniors and younger adults with disabilities. This data spotlight, co-authored by researchers at the Kaiser Family Foundation and the Urban…

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The Henry J. Kaiser Family Foundation

Making Ends Meet: The Medicare Generation

This short Kaiser Family Foundation documentary profiles the experiences of three Medicare families trying to pay for their health care costs with other household spending. The families are among 16 featured in a companion report examining the role Medicare now plays in the lives of beneficiaries and the challenges many…

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