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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.

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.

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.

Income and Assets of Medicare Beneficiaries, 2013 – 2030

This data spotlight, co-authored by researchers at the Kaiser Family Foundation and the Urban Institute, describes the income, savings, and home equity of current Medicare beneficiaries, considers variations by race, ethnicity and other demographic characteristics, and examines the extent to which income and assets are projected to be higher among the next generation of beneficiaries.

Obamacare and You: If You Have Medicare…

This short explainer highlights some of the key information for people with Medicare about how Affordable Care Act, also known as Obamacare, may affect them.

Obamacare and You

Obamacare and You is a series of one-page papers explaining how the Affordable Care Act, also known as “Obamacare,” will affect different groups of people. Click on the links below to learn more: If You Are Uninsured  Haga clic para leer en español  If You Are Low-Income and May Qualify for…

To Switch or Not to Switch: Are Medicare Beneficiaries Switching Drug Plans To Save Money?

This analysis finds that relatively few Medicare beneficiaries have switched Part D prescription drug plans voluntarily during the annual open enrollment period — even though those who do switch often lower their out-of-pocket costs as a result of changing plans. The vast majority (87% on average between 2006 and 2010) stayed in the same Part D plan, even though the plans can change premiums, deductibles, cost-sharing amounts, and their list of covered drugs each year. Higher rates of plan switching were observed in PDPs that increased premiums, increased deductibles, or dropped coverage of brand-name drugs in the coverage gap.

Medicare Part D: A First Look at Plan Offerings in 2014

The 2014 Part D Data Spotlight analyzes information about the Medicare Part D stand-alone prescription drug plan (PDP) options available to beneficiaries in 2014. The analysis shows that Medicare beneficiaries on average will have a choice of 35 stand-alone prescription drug plans in 2014, and somewhat more “benchmark” plans available to Low-Income Subsidy (LIS) beneficiaries nationwide. The weighted average premium will increase by 5 percent between 2013 and 2014 if enrollees remain in the same plans next year. The analysis also finds more plans are using preferred pharmacy networks and adopting a growing number of cost-sharing formulary tiers for different drugs.