Reports Highlight Trends in Medicare Costs and Coverage

A series of new reports from the Commonwealth Fund illustrate trends in costs and benefits associated with the Medicare programs and also examine aspects of the current Senate and House drug bills.

There are currently about 10.2 million elderly and disabled beneficiaries that fall into the near-poor $10,000 - $20,000 income bracket. Medicaid beneficiaries in this income bracket pay higher out of pocket costs for prescriptions than other income groups. According to the Commonwealth Fund, "Average out-of-pocket costs for a couple at 160% of poverty would be reduced only slightly under both the House and Senate bills."

The House and Senate bills that are currently in Congress will phase out premium assistance for those above the 130% poverty level. According to the Commonwealth Fund, "While the Senate bill provides somewhat greater assistance to those at 130% of poverty, it does not provide coverage to Medicaid beneficiaries, leaving the states to pick up those costs."

Another area of debate within the House and Senate bills is in relation to the future of private insurance plans in the Medicare program. Medicare+ Choice enrollees have faced increased costs each year since 1999. Along with these increased costs, benefits have eroded. "Health insurance is designed to protect individuals from high health care costs that could inflict financial hardship," said Karen Davis, president of the Commonwealth Fund. "The steadily increasing financial burden on sicker beneficiaries is of notable concern."

A positive aspect of Medicare coverage is in the assistance it gives to uninsured older adults. When uninsured older adults gain access to Medicare coverage, they are more likely than already insured adults to take advantage of preventative testing measures, such as cholesterol testing and mammography.

According to a recent study by the Journal of American Medical Association (JAMA), "Prior to Medicare eligibility, only 41 percent of uninsured adults examined in the study received cholesterol testing, compared with 76 percent of insured adults. Once uninsured adults became eligible for Medicare coverage, the differences in preventative testing rates between the two groups were dramatically reduced."

"The marked increase in the use of mammography and cholesterol testing show distinct benefits for previously uninsured adults who gain Medicare coverage," said Dr. Ayanian, one of the authors of the JAMA study. "Extending Medicare coverage to these adults before age 65 has the potential to save many lives through prevention or earlier detection and treatment of major medical conditions such as cancer or heart disease."


Posted on August 21, 2003