Medigap coverage and medicare spending: A second look

Health Affairs

Volumn 27, Issue 2, 2008, Pages 469-477

  Lemieux, Jeff ^a   Chovan, Teresa ^a   Heath, Karen ^b  

^a America's Health Insurance Plans   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONTROLLED STUDY; COST CONTROL; HEALTH CARE; HEALTH CARE COST; HEALTH INSURANCE; HEALTH SERVICE; HEALTH STATUS; HEALTH SURVEY; HUMAN; MEDICAL INFORMATION; MEDICARE; MILITARY SERVICE;

AGED; AGED, 80 AND OVER; FEMALE; HEALTH EXPENDITURES; HUMANS; INSURANCE COVERAGE; INSURANCE, MEDIGAP; MALE; MEDICARE; UNITED STATES;

EID: 41749118697     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.27.2.469     Document Type: Article

References (12)

1. The MCBS Cost and Use file is based on three separate contacts with each respondent in a year, and the resulting data are for a full year's worth of coverage under Medicare (and supplemental coverage, if applicable). Note that another MCBS file that is commonly used, the Access to Care file, is based on one contact with each respondent per year. The Access to Care file lends itself more to a point-in-time analysis and shows a higher percentage of Medicare beneficiaries without supplemental coverage. A detailed methodological discussion and extensive backup tables are available online at http://content.healthaffairs.org/cgi/content/full/27/2/469/DC1.
2. Congressional Budget Office, Mandatory: Restrict Medigap Coverage of Medicare's Cost Sharing, Budget Options (Washington: CBO, February 2007).
3. S. Christensen and J. Shinogle, "Effects of Supplemental Coverage on Use of Services by Medicare Enrollees - Innovations in Fee-for-Service Financing and Delivery," Health Care Financing Review 19, no. 1 (1997): 5-17;
4. and Medicare Payment Advisory Commission, Annual Report to the Congress, FY 1996 (Washington: MedPAC, 1996).
5. S.L. Ettner, "Adverse Selection and the Purchase of Medigap Insurance by the Elderly," Journal of Health Economics 16, no. 5 (1997): 543-562.
6. Frank Eppig, director, Medicare MCBS project, Centers for Medicare and Medicaid Services, personal communication, May 2006.
7. Taken independently, the "military" control alone (three or more days in the hospital with small Medicare claims) would have shrunk the apparent gap in Medicare claims between Medigap purchasers and FFS-only beneficiaries by 10 percent based on the 2003 MCBS data, or 13 percent based on the 2002 data. However, virtually all of the records excluded under the "military" control would also have been excluded under the VA control, in both the 2003 and 2002 data. Because of the overlap, excluding VA records alone would have accounted for more than 99 percent of the 45 percent reduction from excluding both VA and "military" records in 2003, and almost 99 percent of the 40 percent reduction estimated from the 2002 data. Additional details are available fromthe authors. Send e-mail to jlemieux@ahip.org.
8. Christensen and Shinogle, "Effects of Supplemental Coverage."
9. Ibid.
10. The ten most expensive diagnoses are congestive heart failure (HCC 80); chronic obstructive pulmonary disease (HCC 108); vascular disease (HCC 105); specified heart arrhythmias (HCC 92); diabetes without complication (HCC 19); breast, prostate, colorectal, and other cancers/tumors (HCC 10); ischemic or unspecified stroke (HCC96); angina pectoris/old myocardial infarction (HCC 83); unstable angina/other acute ischemic heart disease (HCC 82); and cardiorespiratory failure and shock (HCC 79). Additional comparison tables are available online, as in Note 1.
11. "We cannot say much about cost-sharing among those over 65, because Medicare eligibles were excluded from our sample." J.P. Newhouse and the Insurance Experiment Group, Free for All? Lessons from the RAND Health Insurance Experiment (Cambridge, Mass.: Harvard University Press, 1996), 345.
12. A. Chandra, J. Gruber, and R. McKnight, "Patient Cost-Sharing, Hospitalization Offsets, and the Design of Optimal Health Insurance for the Elderly," NBER Working Paper no. 12972 (Cambridge, Mass.: National Bureau of Economic Research, March 2007).