- Title Information
- Title
- Estimating the Cost of an Out-of-Pocket Maximum in Traditional Medicare
- Type of Resource (primo)
- technical_reports
- Abstract
- Traditional Medicare’s (TM) lack of an out-of-pocket maximum, a feature of Medicare Advantage
plans, means that OOP costs can accumulate rapidly for beneficiaries without supplemental
coverage. To increase affordability for TM beneficiaries, Congress could establish an
out-of-pocket maximum. We used data from the 2022 CMS Master Beneficiary Summary File and
performed a simple analysis of the share of non-dual TM beneficiary spending over various OOP
caps of Parts A and B spending. The analysis assumed no impact of the cap on beneficiaries’
choice of supplemental plans and assumed no impact on utilization patterns. From this analysis,
we estimate that a $1,000 out-of-pocket cap on Parts A and B spending would benefit 44% of
non-dual TM beneficiaries and cost $44 billion in 2025, whereas a $10,000 cap would benefit 3.1%
of beneficiaries and cost $8 billion. An out-of-pocket maximum on Part A and B spending greater
than $4,000, would benefit less than 10% of qualified beneficiaries and cost between $8-19 billion
in 2025. While our analysis gives a ballpark estimate of the costs of OOP caps for Parts A and B, a
more detailed analysis should account for likely behavioral effects of OOP caps on beneficiaries’
plan choice or utilization patterns.
- Name
- Name Part
- Meehir Dixit
- Role
- Role Term (marcrelator)
(authorityURI="http://id.loc.gov/vocabulary/relators", valueURI="http://id.loc.gov/vocabulary/relators/aut")
- Author
- Name
- Name Part
- David Meyers
- Role
- Role Term (marcrelator)
(authorityURI="http://id.loc.gov/vocabulary/relators", valueURI="http://id.loc.gov/vocabulary/relators/aut")
- Author
- Name
- Name Part
- Andrew Ryan
- Role
- Role Term (marcrelator)
(authorityURI="http://id.loc.gov/vocabulary/relators", valueURI="http://id.loc.gov/vocabulary/relators/aut")
- Author
- Origin Information
- Date Created
- 2024
- Subject (Local)
- Topic
- Traditional Medicare
- Subject (Local)
- Topic
- Original Medicare
- Subject (Local)
- Topic
- Out-of-Pocket Maximum
- Genre
- Policy Brief
- Access Condition:
use and reproduction
- All rights reserved
- Access Condition:
rights statement
(href="http://rightsstatements.org/vocab/InC/1.0/")
- In Copyright
- Access Condition:
restriction on access
- All Rights Reserved
- Identifier:
DOI
- 10.26300/kb5e-n559