<mods:mods xmlns:mods="http://www.loc.gov/mods/v3" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-8.xsd"><mods:titleInfo><mods:title>Estimating the Cost of an Out-of-Pocket Maximum in Traditional Medicare</mods:title></mods:titleInfo><mods:typeOfResource authority="primo">technical_reports</mods:typeOfResource><mods:abstract>Traditional Medicare’s (TM) lack of an out-of-pocket maximum, a feature of Medicare Advantage&#13;
plans, means that OOP costs can accumulate rapidly for beneficiaries without supplemental&#13;
coverage. To increase affordability for TM beneficiaries, Congress could establish an&#13;
out-of-pocket maximum. We used data from the 2022 CMS Master Beneficiary Summary File and&#13;
performed a simple analysis of the share of non-dual TM beneficiary spending over various OOP&#13;
caps of Parts A and B spending. The analysis assumed no impact of the cap on beneficiaries’&#13;
choice of supplemental plans and assumed no impact on utilization patterns. From this analysis,&#13;
we estimate that a $1,000 out-of-pocket cap on Parts A and B spending would benefit 44% of&#13;
non-dual TM beneficiaries and cost $44 billion in 2025, whereas a $10,000 cap would benefit 3.1%&#13;
of beneficiaries and cost $8 billion. An out-of-pocket maximum on Part A and B spending greater&#13;
than $4,000, would benefit less than 10% of qualified beneficiaries and cost between $8-19 billion&#13;
in 2025. While our analysis gives a ballpark estimate of the costs of OOP caps for Parts A and B, a&#13;
more detailed analysis should account for likely behavioral effects of OOP caps on beneficiaries’&#13;
plan choice or utilization patterns.</mods:abstract><mods:name><mods:namePart>Meehir Dixit</mods:namePart><mods:role><mods:roleTerm authority="marcrelator" authorityURI="http://id.loc.gov/vocabulary/relators" valueURI="http://id.loc.gov/vocabulary/relators/aut">Author</mods:roleTerm></mods:role></mods:name><mods:name><mods:namePart>David Meyers</mods:namePart><mods:role><mods:roleTerm authority="marcrelator" authorityURI="http://id.loc.gov/vocabulary/relators" valueURI="http://id.loc.gov/vocabulary/relators/aut">Author</mods:roleTerm></mods:role></mods:name><mods:name><mods:namePart>Andrew Ryan</mods:namePart><mods:role><mods:roleTerm authority="marcrelator" authorityURI="http://id.loc.gov/vocabulary/relators" valueURI="http://id.loc.gov/vocabulary/relators/aut">Author</mods:roleTerm></mods:role></mods:name><mods:originInfo><mods:dateCreated>2024</mods:dateCreated></mods:originInfo><mods:subject authority="local"><mods:topic>Traditional Medicare</mods:topic></mods:subject><mods:subject authority="local"><mods:topic>Original Medicare</mods:topic></mods:subject><mods:subject authority="local"><mods:topic>Out-of-Pocket Maximum</mods:topic></mods:subject><mods:genre>Policy Brief</mods:genre><mods:accessCondition type="use and reproduction">All rights reserved</mods:accessCondition><mods:accessCondition type="rights statement" xlink:href="http://rightsstatements.org/vocab/InC/1.0/">In Copyright</mods:accessCondition><mods:accessCondition type="restriction on access">All Rights Reserved</mods:accessCondition><mods:identifier type="doi">10.26300/kb5e-n559</mods:identifier></mods:mods>