View Research by Author - Misha Segal

Citation URL: http://www.urban.org/MishaSegal

While data limitations from the Medicare Current Beneficiary Survey make direct comparisons between HMOs and traditional Medicare spending misleading, it is still important to examine the out of pocket spending in HMOs. This paper looked at patient characteristics including health status, age and income differences in out of pocket costs. Just as with the traditional Medicare program, out of pocket costs are considerably higher for those in poor or fair health. Thus, even though costs for beneficiaries are likely to be lower overall, the same types of patterns with sicker beneficiaries paying more occur. Another finding was that while HMOs offer drug coverage, beneficiaries still pay a considerable amount out of pocket. (Published by The Commonwealth Fund; 2000 July.)

This paper looks at three years of projections of the future costs of Medicare and assesses various tax and spending options to put the program on firmer financial footing in the future. For the three years examined, 1998 through 2000, projections of the share of GDP that Medicare will consume dropped steadily as the economy continued to be strong and the Balanced Budget Act had a greater impact on spending than many had assumed. While tax revenues will likely be needed in the future, the level of those tax increases can be quite modest if some changes begin to be made in the near future. (Inquiry 2000/2001 Winter; 37(4): 338-347).

Medicare, the nation's largest public health insurance program, faces formidable challenges in the years ahead. To ensure its stability, the program will have to come to grips with the combined impact of escalating health care spending, insufficient revenues, and a burgeoning elderly population. Proposals for changes in the program itself and its financing have been put on the table. As policymakers debate the merits of these various options, they must consider the effect on Medicare beneficiaries and protect vulnerable elderly and disabled people from overwhelming out-of-pocket costs.

This paper examines ways to improve the Medicare Savings programs, i.e. the Qualified Medicare Beneficiaries Program (QMB) and the Specified Low Income Medicare Beneficiaries program (SLMB). These two programs offer fill-in benefits for Medicare to persons with low incomes. While some of the QMB program serves those with Medicaid, the real advantages are for beneficiaries who otherwise would not qualify for support. But participation has remained low in these programs likely because of lack of knowledge by beneficiaries and lack of enthusiasm by some states that administer QMB and SLMB. Among the options examined were efforts to increase participation by eliminating the asset limits and by federalizing the program. (Inquiry 1998 Fall; 35(3): 346-356).

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