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Streamlining Cost Sharing in Medicare: The Impact on Beneficiaries.

Monday, July 22, 2013

Recent proposals to combine the two main parts of Medicare would mean streamlining deductibles and other cost-sharing for beneficiaries. But health care policy experts are cautioning that such a change is complicated and requires analysis. A July 22 briefing explored the impact on beneficiaries.

The idea of redesigning Medicare's benefits has gained increased attention from both Congress and the president in recent years. Medicare, with Parts A, B and D, has a complicated benefit structure, with various cost-sharing requirements and no limit on out-of-pocket spending. As a result, most beneficiaries in traditional Medicare have some form of supplemental insurance coverage (employer-sponsored retiree health plans, Medigap policies, or Medicaid) to help fill in the gaps. Several proposals would combine deductibles for Parts A and B, establish uniform coinsurance rates across benefits, set a limit on beneficiaries' out-of-pocket spending, and discourage or restrict supplemental coverage.

What are some of the key elements in proposals to restructure Medicare’s cost sharing? How would these reforms impact Medicare beneficiaries? What would these changes mean for retiree health benefits and the employers that provide them? What effect would these proposals have on Medicare spending?

A distinguished panel of experts addressed these and related questions.

Juliette Cubanski, associate director of the Program on Medicare Policy at the Kaiser Family Foundation, described Medicare’s current cost-sharing structure and the implications for beneficiaries of a restructured benefit design, along with restrictions on supplemental coverage.

Sheila Burke, co-director of the Health Project at the Bipartisan Policy Center and adjunct lecturer in public policy at Harvard's Kennedy School of Government, spoke about recommendations on the redesign of benefits and why a particular set of changes would be favored.

Joe Baker, president of the Medicare Rights Center, provided a consumer perspective about the impact of different cost-sharing proposals on beneficiaries.

Frank McArdle, independent benefits consultant, discussed implications of various proposals on retiree health benefits and employers.

Ed Howard of the Alliance and Tricia Neuman of Kaiser moderated the discussion

The event was sponsored by the nonpartisan Alliance for Health Reform and The Kaiser Family Foundation.

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Transcript (Adobe Acrobat PDF), 7/22/2013
Full Webcast/Podcast: Briefing video from CSPAN

Speaker Presentations

Neuman Presentation (Adobe Acrobat PDF), 7/22/2013
Baker Presentation (Adobe Acrobat PDF), 7/22/2013
Burke Presentation (Adobe Acrobat PDF), 7/22/2013
Cubanski Presentation (Adobe Acrobat PDF), 7/22/2013

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 7/22/2013
Speaker Biographies (Adobe Acrobat PDF), , 7/22/2013
Selected Experts (Adobe Acrobat PDF), , 7/22/2013
Materials List (Adobe Acrobat PDF), , 7/22/2013

Offsite Materials (briefing documents saved on other websites)

An Overview of the Medicare Program and Medicare Beneficiaries’ Costs and Service Use (Adobe Acrobat PDF),Kaiser Family Foundation, 2/27/2013
Nonpartisan Report Underscores Need to Protect Financially Vulnerable Seniors, Partnership for Quality Home Healthcare, 6/13/2013
Testimony before the House Committee on Energy and Commerce Subcommittee on Health (Adobe Acrobat PDF),Harvard School of Public Health, 6/26/2013
The President’s and Other Bipartisan Proposals to Reform Medicare (Adobe Acrobat PDF),Medicare Rights Center, 5/21/2013
Three Reasons Why Medicare Cost-Shifting Is the Wrong Solution, Huff Post Politics, 2/21/2013
Restructuring Medicare (Adobe Acrobat PDF),Health Affairs, 6/20/2013
Restructuring Medicare’s Benefit Design, Implications for Beneficiaries and Spending (Adobe Acrobat PDF),Kaiser Family Foundation, 11/1/2011
A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment (Adobe Acrobat PDF),Bipartisan Policy Center, 4/18/2013
Financial Security of Elder Americans at Risk, Proposed Changes to Social Security and Medicare Could Make a Majority of Seniors ‘Economically Vulnerable’ (Adobe Acrobat PDF),Economic Policy Institute, 6/6/2013
Medigap: Spotlight on Enrollment, Premiums and Recent Trends (Adobe Acrobat PDF),Kaiser Family Foundation, 4/1/2013
Daring to Be Cautious?: Bigger Steps Needed for Medicare Cost-Sharing Reform (Adobe Acrobat PDF),American Enterprise Institute, 3/28/2013
Medicare and the Federal Budget: Comparison of Medicare Provisions in Recent Federal Debt and Deficit Reduction Proposals (Adobe Acrobat PDF),Kaiser Family Foundation, 6/21/2013
Double Coverage: How it Drives Up Medicare Costs for Patients and Taxpayers (Adobe Acrobat PDF),The Heritage Foundation, 6/4/2013
Medigap Reforms: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs (Adobe Acrobat PDF),Kaiser Family Foundation, 7/20/2011
Rethinking Medicare’s Benefit Design: Opportunities and Challenges (Adobe Acrobat PDF),Kaiser Family Foundation, 6/26/2013
Alice Rivlin Testimony Before the United States House of Representatives Committee on Ways and Means Subcommittee on Health (Adobe Acrobat PDF),United States House of Representatives Committee on Ways and Means Subcommittee on Health, 5/21/2013
Original Medicare Costs in 2013 (Adobe Acrobat PDF),Medicare Rights Center, 1/1/2013
Restructuring Medicare Cost Sharing: Exploring Options to Protect Low-Income Beneficiaries (Adobe Acrobat PDF),National Health Policy Forum, 7/15/2013
Value-Based Cost Sharing In The United States And Elsewhere Can Increase Patients’ Use Of High-Value Goods And Services, Health Affairs, 4/1/2013


Increased exposure to cost sharing could result in decreased use of necessary care, Juliette Cubanski, associate director of the Program on Medicare Policy at the Kaiser Family Foundation, stated at a July 22 Alliance for Health Reform briefing, Streamlining Cost Sharing in Medicare: The Impact on Beneficiaries.  

Proposals should cap catastrophic cost and cost sharing by beneficiaries, Sheila Burke, co-director of the Health Project at the Bipartisan Policy Center and adjunct lecturer in public policy at Harvard’s Kennedy School of Government, said at a July 22 Alliance for Health Reform briefing, Streamlining Cost Sharing in Medicare: The Impact on Beneficiaries.

Cost sharing should never shift costs to beneficiaries, Joe Baker, president of the Medicare Rights Center, said at a July 22 Alliance for Health Reform briefing, Streamlining Cost Sharing in Medicare: The Impact on Beneficiaries.

If supplemental coverage is to be changed, it should not make medicare program more volatile, Frank McArdle stated at a July 22 Alliance for Health Reform briefing, Streamlining Cost Sharing in Medicare: The Impact on Beneficiaries.


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