Page images
PDF
EPUB
[blocks in formation]

Table 8 Medicaid Income Eligibility Limits for Elderly Couples, 1989

State

[blocks in formation]
[blocks in formation]
[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small]

*209(b) states; may use more restrictive criteria than the SSI standard ($6,636 per year for couples at 83% of poverty) to determine Medicaid eligibility. ** 1986 OBRA eligibility level used.

-Signifies option not covered by state.

NA Information was not available.

(a) Eligibility criteria is the higher of either state categorically needy or 1986 OBRA Buy-in eligibility criteria.

(b) The Official Federal Poverty level for 1989 is $8,020/year for couples, except in Alaska ($10,025/year) and Hawaii ($9,223/year).

(c) Not effective until January 1, 1990.

(d) Nevada does not use a separate eligibility level for couples.

SOURCE: Rowland, Saiganicoff, and Lyons, 1990.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

the protection available to poor elderly people under the Medicaid program (Christensen and Kasten, 1988). As of July 1992, all states will be required to provide Medicaid coverage for Medicare premiums and cost-sharing to all elderly individuals and couples with incomes below the poverty level and assets of less than $4,000 for individuals and $6,000 for couples. The new asset levels are twice as high as the SSI resource standards. This provision was retained despite the repeal of most of the other parts of the Catastrophic Coverage legislation.

Under the Medicare buy-in provision, states provide financial assistance to beneficiaries by paying the Medicare Part B premium as well as deductibles and coinsurance arising from use of covered medical services. Those covered by "buy-in" are referred to as "qualified Medicare beneficiaries or QMBs." These individuals, however, are still not eligible for full Medicaid benefits, including services such as prescription drugs and hearing and vision care. Thus, the buy-in population has less comprehensive coverage than those who are entitled to full benefits (Rowland, Salganicoff, and Lyons, 1989).

Medicaid assistance to poor elderly people is limited because participation rates are low. It is estimated that half of beneficiaries potentially eligible for SSI and Medicaid coverage do not enroll (Commonwealth Fund Commission, 1987). About half of those not participating appear to be unaware of the program or of their own potential eligibility. Many elderly people do not appear to understand the benefits available under Medicaid and others are reluctant to apply to a welfare-based program.

Medicaid provides even more limited assistance to the near-poor. Only 11 states cover individuals with incomes at or above the poverty level and no states provide assistance to individuals with incomes over 150 percent of poverty. As a result, only 10 percent of the near-poor receive any assistance from Medicaid. Many who are covered spend-down as a result of large medical bills. Without Medicaid coverage, the near-poor must pay Medicare premiums as well as purchase private insurance if they want help with Medicare cost-sharing. These premium payments alone can leave them economically strapped.

Lack of Supplemental Coverage-The 6.5 million elderly people who rely solely on Medicare for assistance with medical bills are particularly at-risk for impoverishment should they incur large medical bills. Poor and near-poor elderly people are the most likely to be without either Medicaid or private insurance to supplement Medicare. Thirty-four percent of poor and 28 percent of near-poor elderly people rely solely

[blocks in formation]
[blocks in formation]

adjusted for socioeconomic characteristics and health status

SOURCE: Congressional Budget Office, 1989 based on analysis of the 1987 National Medical Expenditure Survey.

Elderly people with Medicare-only coverage are twice as likely to have no physician visits during a year as those with supplemental coverage. Sixteen percent of elderly people with Medicare only report no physician visits in contrast to eight percent of those with private insurance and seven percent of those with Medicaid (Figure 8). Among those who use physician services, adequacy of financial protection through coverage to supplement Medicare again plays a significant role. After adjusting for health status, the elderly users of physician care with Medicare-only coverage average 6.3 physician visits per

year compared to 8.4 visits for those with Medicaid coverage or private insurance to supplement Medicare.

Access for physician services has spillover effects on utilization of other health care services. Physicians prescribe medications for their patients and Medicare beneficiaries, especially those in fair or poor health, are heavy users of prescription drugs (Moeller and Mathiowetz, 1989). It is therefore not surprising that the lower levels of physician care for those with Medicare-only coverage are also associated with reduced levels of prescription drug use. The Medicareonly population averages 12 prescriptions per year compared to 16 for the privately insured population and 17 prescriptions for the Medicaid population (Figure 9). Since Medicare does not cover prescription drugs, but Medicaid and some private insurance plans do, the combined influence of economic cost and physician access undoubtedly contributes to the lower use levels by the Medicare-only population.

Figure 9 Utilization of Prescription Drugs* by the Elderly Population by Insurance Coverage, 1987

Similarly, the hospitalization rates for the elderly appear to have both economic and physician access implications. The poor without coverage to supplement Medicare have 26 hospitalizations per 100 people compared to 46 hospitalizations per 100 for the privately insured non-poor population (Figure 10). Although the poor who report their health as fair or poor fare better, they still lag behind those with better insurance coverage. After adjusting for health status, the poor population with Medicare-only coverage has a hospitalization rate of 42 hospitalizations per 100 people compared to 57 hospitalizations per 100 nonpoor elderly people. Despite poor health status, elderly people with incomes at or below poverty who are at risk for full payment of Medicare's hospital deductible and cost-sharing burdens appear to receive less care than their more affluent and better insured counterparts.

[merged small][merged small][graphic][subsumed][subsumed]
[blocks in formation]
[blocks in formation]

Total Elderly

Elderly In Fair or Poor Health

SOURCE: Johns Hopkins University estimates of the non-institutionalized elderly based on the 1984 Supplement on Aging to the National Health Interview Survey.

adjusted for socioeconomic

characteristics and health status

SOURCE: Congressional Budget Office, 1989 based on analysis of the 1987 National Medical Expenditure Survey.

Financial Burden for Medical Care

Medicare provides essential protection for medical care expenses for elderly Americans by financing

most hospital and physician care. Yet Medicare coverage is neither comprehensive nor free. Many acute care services, most notably prescription drugs, dental care, and vision and hearing services, are not covered by Medicare. The elderly contribute to Medicare by paying a monthly premium for physician services under Part B and paying cost-sharing and deductibles when services are used.

The financial burden associated with out-of-pocket payments for Medicare premiums and services can be substantial, especially for low-income elderly people. In 1990, the hospital deductible is $542 per spell of illness combined with a $75 deductible and 20 percent coinsurance on most Part B services (Figure 11). Those with extended hospital stays or multiple admissions can incur even greater liabilities (Christensen, Long, and Rodgers, 1987). Moreover, regardless of use of health services, all beneficiaries pay a premium of $28.60 per month for Part B services, totalling $343 for 1990.

[blocks in formation]
[blocks in formation]

Mean Income......

Medicare Liability as a Percent of Mean Income 5% 18% 10% 4% *Includes both institutional and community-based elderly Medicare enrollees. ** Premium effective as of January 1, 1990. SOURCE: Christensen, S., 1989.

[blocks in formation]

Out-of-Pocket Spending and Income-On average, elderly people living in the community spend 11 percent of their per capita incomes on out-of-pocket payments for Medicare cost-sharing, uncovered services, and premium payments (Figure 12). These expenses consume a greater portion of the income of lowincome people than of higher income individuals (Feder, Moon, and Scanlon, 1987b). The poor and near-poor with per capita incomes of less than $10,000 spent an average of 14 percent of income on medically-related expenses compared to seven percent of income for the non-poor elderly population with incomes above $10,000.

The components of out-of-pocket medical spending by the elderly population reveal the substantial share of spending attributable to premium payments (Figure 13). Over half of all out-of-pocket costs of elderly people are for premiums. The Medicare Part B premium accounts for 16 percent of total spending and payments for private supplementary coverage constitute 40 percent of total spending. Prescription drugs account for 12 percent of spending (Table 12). An examination of out-of-pocket spending by income shows

« PreviousContinue »