Seven-                                                 
Source              Year             Description                      Comments
                   Savings
Cost Sharing      $26.0 b  Require enrolles to pay         Cost sharing on Part A
                           20% coinsurance for each day    services will place a heavier
                           in a skilled nursing facility   burden on the very old and
                                                           frail who are more likely to
                                                           use institutional and home
                           Implement home health           health services.
                           copay of $5/ visit              
                                                           Out-of-pocket costs may be
                                                           extremely high for those
                           Increase Part B deductible      without supplemental coverage.
                           from $100 to $150 and index to  
                           the consumer price index        Presence of supplemental
                                                           insurance blunts importance of
                                                           cost sharing on behavior.
                           Cost sharing on          
                           outpatient services and reduced The home health copay is kept
                           outlays as described in         smaller and treated as a flat
                           outpatient section would save   payment because of potentially
                           beneficiaries about $17         large burdens on users of
                           billion; this savings is        these services.
                           implicitly included in the
                           estimates of provider savings)
                           
Premiums          $85.1 b  Shift home health to Part       In contrast to changes in cost
                           B and implement an income-      sharing, premium increases are
                           related premium.   Individuals  more evenly spread across all
                           with incomes less than $50,000  beneficiaries.
                           ($65,000 for couples) would pay 
                           a premium equal to 27% of Part  This change would also affect
                           B costs.  The share would rise  both beneficiaries who go into
                           progressively up to a ceiling   private plans and those who
                           of 50% for individuals with     remain in FFS.
                           incomes above $60,000 ($80,000  
                           for couples).                   
                           
Shift  Qualified   ($40.0  QMB would be moved out of       Without further expansion
Medicare             b)    Medicaid and into Medicare      (and/or federalization) of QMB
Beneficiary (QMB)                                          program, changes in cost
Program to                                                 sharing and premiums could
Medicare                                                   fall heavily on persons with
                                                           modest incomes.
                                                           
                                                           Moving QMB to Medicare would
                                                           also likely increase
                                                           participation.