Open AccessMedicaid Coverage ‘Cliff’ Increases Expenses And Decreases Care For Near-Poor Medicare Beneficiaries
Author(s) -
Eric T. Roberts,
Alexandra Glynn,
Noelle Cornelio,
Julie M. Donohue,
Walid F. Gellad,
J. Michael McWilliams,
Lindsay M. Sabik
Publication year - 2021
Publication title -
health affairs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.837
H-Index - 178
eISSN - 2694-233X
pISSN - 0278-2715
DOI - 10.1377/hlthaff.2020.02272
Subject(s) - medicaid , poverty , subsidy , cost sharing , medicare part d , prescription drug , business , medical prescription , medicine , health care , nursing , economic growth , economics , market economy
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.