Schoen Cathy, Davis Karen, Willink Amber, Buttorf Christine
New York Academy of Medicine, New York, NY.
Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Issue Brief (Commonw Fund). 2018 Sep 1;2018:1-15.
An estimated 40 percent of low-income Medicare beneficiaries spend 20 percent or more of their incomes on premiums and health care costs. Low-income beneficiaries with multiple chronic conditions or high need are at particular risk of financial hardship. High cost burdens reflect Medicare premiums and cost-sharing, gaps in benefits, and limited assistance. Existing policies to help people with low incomes are fragmented — meaning that beneficiaries apply separately, sometimes to different offices — and require Medicare beneficiaries to navigate complex applications.
With the goal of enhancing access and affordability for people vulnerable due to low incomes and poor health, this issue brief proposes a policy that would reduce Medicare’s cost-sharing and premiums for beneficiaries with incomes below 150 percent of the federal poverty level.
Profile current cost burdens by income groups and assess the potential impact of a policy to expand cost-sharing and premium assistance using the 2012 Medicare Current Beneficiary Survey projected to 2016.
The policy described could help 8.1 million low-income beneficiaries, significantly lowering their risk of high cost burdens. It also could simplify the administration of assistance provided to these enrollees.
据估计，40%的低收入医疗保险受益人将其收入的20%或更多用于支付保费和医疗费用。患有多种慢性病或有高需求的低收入受益人面临经济困难的风险尤其高。高昂的成本负担反映了医疗保险保费和费用分摊、福利缺口以及有限的援助。现有的帮助低收入人群的政策分散——这意味着受益人要分别申请，有时要向不同的办公室申请——并且要求医疗保险受益人应对复杂的申请流程。
为了提高因低收入和健康状况不佳而处于弱势的人群获得医保服务的机会并降低他们的负担，本问题简报提出一项政策，该政策将降低联邦贫困线150%以下受益人的医疗保险费用分摊和保费。
按收入群体描述当前的成本负担，并利用预计到2016年的2012年医疗保险当前受益人调查评估扩大费用分摊和保费援助政策的潜在影响。
所描述的政策可以帮助810万低收入受益人，显著降低他们承担高额成本负担的风险。它还可以简化向这些参保人提供援助的管理工作。
