Eric T. Roberts (
Alexandra Glynn is a doctoral student in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health.
Health Aff (Millwood). 2021 Apr;40(4):552-561. doi: 10.1377/hlthaff.2020.02272.
Cost sharing in traditional Medicare can consume a substantial portion of the income of beneficiaries who do not have supplemental insurance from Medicaid, an employer, or a Medigap plan. Near-poor Medicare beneficiaries (with incomes more than 100 percent but less than 200 percent of the federal poverty level) are ineligible for Medicaid but frequently lack alternative supplemental coverage, resulting in a supplemental coverage "cliff" of 25.8 percentage points just above the eligibility threshold for Medicaid (100 percent of poverty). We estimated that beneficiaries affected by this supplemental coverage cliff incurred an additional $2,288 in out-of-pocket spending over the course of two years, used 55 percent fewer outpatient evaluation and management services per year, and filled fewer prescriptions. Lower prescription drug use was partly driven by low take-up of Part D subsidies, which Medicare beneficiaries automatically receive if they have Medicaid. Expanding eligibility for Medicaid supplemental coverage and increasing take-up of Part D subsidies would lessen cost-related barriers to health care among near-poor Medicare beneficiaries.
在传统的 Medicare 中，没有补充保险（来自 Medicaid、雇主或 Medigap 计划）的受益人可能会花费相当一部分收入来承担自付费用。接近贫困线的 Medicare 受益人（收入超过联邦贫困线的 100%但低于 200%）没有资格获得 Medicaid，但他们经常缺乏其他补充性保险，这导致在 Medicaid 资格线（贫困线的 100%）之上存在一个 25.8%的补充性保险“悬崖”。我们估计，受这种补充性保险悬崖影响的受益人在两年内额外增加了 2288 美元的自付费用，每年减少了 55%的门诊评估和管理服务的使用量，开的处方也更少。处方药使用率的下降部分是由于 Part D 补贴的利用率较低造成的，如果受益人有 Medicaid，他们会自动获得 Medicare 补贴。扩大 Medicaid 补充保险的资格范围并增加 Part D 补贴的利用率，将减轻接近贫困线的 Medicare 受益人的医疗保健相关费用障碍。
