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The State of Coverage to Supplement Medicare in Massachusetts

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(1)

The State of Coverage

to Supplement Medicare

in Massachusetts

SEPTEMBER 24, 2015

(2)

Medicare covers nearly

1.2 million

residents of Massachusetts.

~900,000 people

age 65 or older

~300,000 people

under age 65

with disabilities

(3)

Medicare has many gaps.

PART A

PART B

PART D

Premium

For some, up to

$407/month

$105/month (and more for

those with higher income)

Depends on plan selected

Deductible

$1,260 per benefit period

(can have >1 per year)

$147 per year

$320/year

Copayments/

Coinsurance

$315-$630 per day for

hospital

20% for physician

and other medical

(including diagnostic)

25% up to $2,960

in total drug costs

45% / 65% between

$2,960 and $6,680

Benefit

Limits

100 days/SNF

190 psychiatric hospital

days /lifetime

(4)

Coverage to supplement Medicare is an

important source of financial protection.

232,000

218,000

279,000

111,000

Medigap Plans

Medicare

Advantage Plans

MassHealth

GIC/Federal

Retirees

Other or None

TYPE OF SUPPLEMENTAL COVERAGE

?

(5)

Prescription drug coverage is vital, too.

449,000

213,000

7,000

111,000

279,000

0

Stand-alone

PDP

Advantage

Medicare

with Rx

Medigap

with Rx

GIC/Federal

Retirees

MassHealth Other or None

?

Number of Medicare Beneficiaries in Massachusetts, 2013

(6)

Lots of Private Plan Choices

18

Medigap Products

35

Medicare Advantage Products

(7)

A variety of other public programs provide

additional coverage and financial protection.

EXTRA HELP

HEALTH SAFETY NET

(8)

Issue #1:

Lack of Health Insurance

~50,000+ elders each year have a period without coverage

45,000 have a spell without coverage

6,000 had no coverage for the entire year

Some ineligible for premium-free Medicare Part A

Medicare Part A premium can be $400/month

Workers more likely to be ineligible for Medicare:

Domestic workers, seasonal workers, and migrant workers,

some federal, state, and local government retirees

(9)

Issue #2:

Supplemental coverage is expensive,

particularly relative to average income.

10%

28%

22%

40%

12%

27%

13%

47%

$0

$1 to $69

$70 to 139

$140+

December 2014

February 2015

MONTHLY PREMIUM

Distribution of Members by Monthly Premium:

Medicare Advantage Direct Pay Members with Prescription Drug Coverage

(10)

Premiums and Out-of-Pocket

Spending Limit

Annual

Amount

As a percent of Average

Social Security Benefit in

Massachusetts ($16,000)

Medicare Part B Premium

$1,259

Medicare Advantage Premium

(most popular product)

$2,546

Total Premiums

$3,808

24%

Plus

: Total out-of-pocket spending

limit (for covered services)

$3,400

Total Premiums and Out-of-pocket

$7,208

45%

Issue #2:

Supplemental coverage is expensive,

particularly relative to average income.

(11)

Type of Plan

Range of Premium Increase:

2009 to 2015

Medigap Plans

Medicare Advantage Plans

Prescription Drug Plans

Social Security Benefits COLA increase

-7%

-27%

-1%

+8.7%

+36%

+214%

+47%

Issue #3:

Premiums for the most

popular private plans are increasing rapidly

and much faster than Social Security benefits.

to

to

to

(12)

Issue #4:

Private coverage and public programs

are complicated and fragmented, making

them hard to understand and navigate.

Lots of different private plans choices

Different rules for different public programs

Income and asset amounts vary

Application process can be complex

Different agencies responsible for different programs

Many people eligible but not enrolled

Less than one-third of eligibles in U.S. enrolled in the Medicare

Savings Programs

(13)

Issue #5:

Elders may have less access to affordable health

coverage than non-elders with the same income.

PEOPLE AGE

65 OR OLDER

ADULTS UNDER AGE 65

MassHealth

(for community-residing

individuals)

100% FPL

plus asset

test

People with disabilities

(ages 0-64)

No income limit

; those with

higher incomes pay premiums

Former foster care

children up to age 26

No income limit

Individuals with breast or

cervical cancer

250% FPL

Pregnant women and

persons with HIV

200% FPL

Adults without one of the

above conditions

133% FPL

Connector Care

(for those without

access to affordable ESI)

Not eligible

Up to 300% FPL

; sliding scale premiums based on income.

(14)

Issue #6:

Little ongoing publicly available

analysis and synthesis about this important

part of the health insurance market

Dozens (hundreds?) of reports on costs, coverage, access,

(15)

IN CONTRAST,

Major public reports on coverage to

supplement Medicare, affordability, access

to services and care among Medicare

(16)

References

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