Chatterjee Paula, Macneal Eliza, Patel Syama R, Roberts Eric T
Department of Medicine, University of Pennsylvania Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (P.C., E.T.R.).
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (E.M., S.R.P.).
Ann Intern Med. 2024 Dec;177(12):1601-1609. doi: 10.7326/ANNALS-24-00787. Epub 2024 Oct 29.
High out-of-pocket costs in Medicare may leave many beneficiaries in financial precarity. Beneficiaries with modest incomes are often ineligible for Medicaid (which covers most out-of-pocket Medicare costs) and may have insufficient resources to pay an unexpected health care bill. This has prompted calls to improve financial protections, but the target population remains uncharacterized.
To identify beneficiaries who would face financial precarity if exposed to the Medicare Part A hospital deductible ($1600).
Cross-sectional study of the 2018 wave of the Health and Retirement Study.
United States.
Community-dwelling Medicare beneficiaries with incomes greater than 100% to 400% or less of the federal poverty level.
Nationally representative estimates of financial precarity, defined as having insufficient funds to pay the deductible, examined across 4 scenarios that considered checking and savings account balances, total liquid assets (with a reserve for future living costs), and supplemental insurance.
Among 4881 beneficiaries (population weighted = 26 619 823), 45.0% had insufficient funds in checking and savings accounts to pay the Medicare hospital deductible. Financial precarity was more prevalent among Black and Hispanic versus White beneficiaries (73.5% and 76.2% vs. 36.2%), those with less versus more than high school education (70.0% vs. 37.1%), and those with 3 or more versus 2 or fewer chronic conditions (49.2% vs. 39.1%). In defining financial precarity to include beneficiaries with insufficient liquid assets to pay the deductible while maintaining a $5000 reserve for future living expenses, 50.7% were financially precarious. Building off this definition to assume supplemental insurance covered the deductible, 39.0% remained financially precarious.
Cost-sharing exposure is limited to hospitalization.
Many Medicare beneficiaries with modest incomes are at risk for financial hardship from costs of a single hospital stay.
National Institute on Aging.
医疗保险中高额的自付费用可能使许多受益人陷入经济不稳定状态。收入不高的受益人往往没有资格享受医疗补助（医疗补助涵盖了医疗保险中大部分的自付费用），并且可能没有足够的资金来支付一笔意外的医疗费用账单。这促使人们呼吁加强经济保障，但目标人群仍未得到明确界定。
确定如果面临医疗保险A部分的住院免赔额（1600美元）就会面临经济不稳定的受益人。
对2018年健康与退休研究浪潮进行的横断面研究。
美国。
收入高于联邦贫困线100%至400%或更低的社区居住医疗保险受益人。
对经济不稳定进行全国代表性估计，经济不稳定定义为没有足够资金支付免赔额，在考虑支票和储蓄账户余额、总流动资产（为未来生活成本预留储备）和补充保险的4种情况下进行了考察。
在4881名受益人中（人口加权=26619823），45.0%的人在支票和储蓄账户中没有足够资金支付医疗保险住院免赔额。与白人受益人相比，黑人和西班牙裔受益人的经济不稳定情况更为普遍（分别为73.5%、76.2%和36.2%），受教育程度低于高中的人与高于高中的人相比（分别为70.0%和37.1%），患有3种或更多慢性病的人与患有2种或更少慢性病的人相比（分别为49.2%和39.1%）。在将经济不稳定定义为包括流动资产不足支付免赔额但为未来生活费用保留5000美元储备的受益人时，50.7%的人经济不稳定。在此定义基础上假设补充保险涵盖免赔额，39.0%的人仍经济不稳定。
费用分担风险仅限于住院治疗。
许多收入不高的医疗保险受益人因单次住院费用而面临经济困难风险。
国家老龄问题研究所。
