Medicare's Role for People Under Age 65 with Disabilities
Issue Brief
This provision was included in the Social Security Amendments of 1972, with Medicare coverage effective July 1, 1973.
Centers for Medicare & Medicaid Services (CMS), Office of Enterprise Data and Analysis, Office of the Actuary, CMS Fact Facts, available at https://www.cms.gov/fastfacts/.
CMS, 2013 Medicare & Medicaid Statistical Supplement, Table 2.1 Medicare Enrollment: Hospital Insurance and/or Supplementary Medical Insurance Programs for Total, Fee-for-Service and Managed Care Enrollees as of July 1, 2012: Selected Calendar Years 1966-2012.
In 2014, 4.5 million people on Medicare age 65 or older (10% of all beneficiaries age 65 or older) initially qualified for Medicare due to receiving disability insurance benefits, having end-stage renal disease, or both prior to turning age 65; based on Kaiser Family Foundation analysis of a five percent sample of 2014 Medicare claims from the CMS Chronic Conditions Data Warehouse.
In 2014 0.3 million people on Medicare under age 65 (3% of all beneficiaries under age 65) qualified for Medicare due to having ESRD (separate estimates for ALS are not available); based on Kaiser Family Foundation analysis of a five percent sample of 2014 Medicare claims from the CMS Chronic Conditions Data Warehouse.
U.S. Social Security Administration, Office of Retirement and Disability Policy, Office of Research, Evaluation, and Statistics, Annual Statistical Report on the Social Security Disability Insurance Program, 2014, November 2015, Table 6: Beneficiaries in Current-Payment Status, Distribution, by sex and diagnostic group, December 2014, available at: http://www.socialsecurity.gov/policy/docs/statcomps/di_asr/2014/.
We scaled respondents’ income estimates reported in the Medicare Current Beneficiary Survey to match income distribution estimates from The Urban Institute’s 2012 Dynamic Simulation of Income Model (DYNASIM).
This applies to Medicare beneficiaries residing in the community; for facility residents, the definition of cognitive/mental impairment also includes ability to recall names and faces, current season, location of nursing home, and room.
We assign supplemental coverage in the following order: Medicare Advantage, Medicaid, employer, Medigap, other, none. Beneficiaries with multiple sources of coverage are assigned to the highest category in the ordering.
Our methodology of assigning supplemental coverage in a hierarchical manner understates the share of beneficiaries with Medicaid, since those who also have Medicare Advantage are included in that coverage group. In 2012, a total of 45% of beneficiaries under age 65 with disabilities and 14% of beneficiaries age 65 or older were dually-eligible for Medicare and Medicaid.
See https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html; see also Kaiser Family Foundation, “Medigap: Spotlight on Enrollment, Premiums, and Recent Trends,” April 2013, available at https://www.kff.org/medicare/report/medigap-enrollment-premiums-and-recent-trends/.
Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2013 Access to Care file.
Analysis of per capita Medicare and out-of-pocket spending among beneficiaries enrolled in Medicare Advantage plans is not possible due to lack of or insufficient data.
Juliette Cubanski, Tricia Neuman, and Anthony Damico, “Similar But Not the Same: How Medicare Per Capita Spending and Service Use Compares for Younger and Older Beneficiaries,” Kaiser Family Foundation, August 2016, available at https://www.kff.org/medicare/issue-brief/similar-but-not-the-same-how-medicare-per-capita-spending-compares-for-younger-and-older-beneficiaries.
Analysis of service use among beneficiaries enrolled in Medicare Advantage plans is not possible due to lack of data.
Irrespective of the supplemental coverage hierarchy, these estimates are 45% and 14%, respectively. See endnotes 9 and 10.
Juliette Cubanski and Tricia Neuman, “Medicare Doesn’t Work As Well for Younger, Disabled Beneficiaries As It Does for Older Enrollees,” Health Affairs, September 2010, vol. 29 no. 9 1725-1733.