A Tax on Work for the Elderly: Medicare as a Secondary Payer

Medicare as a Secondary Payer (MSP) legislation requires employer-sponsored health insurance to be a primary payer for Medicare-eligible workers at firms with 20 or more employees. While the legislation was developed to better target Medicare services to individuals without access to employer-sponsored insurance, MSP creates a significant implicit tax on working beyond age 65. This implicit tax is approximately 15-20 percent at age 65 and increases to 45-70 percent by age 80. Eliminating this implicit tax by making Medicare a primary payer for all Medicare-eligible individuals could significantly increase lifetime labor supply due to the high labor supply elasticities of older workers. The extra income tax receipts from such a policy would likely offset a large percentage of the estimated costs of making Medicare a primary payer.

Federal Employees Health Benefits Program (FEHBP): Available Health Insurance Options

FEHBP is generally available to employees, annuitants, and their dependents. Eligible individuals may elect coverage in an approved health benefits plan for either individual or family coverage. For the 2013 plan year, there are about 230 different plan choices, including all regionally available options. As a practical matter, an individual’s choice of plans is often limited to 10 to 15 different plans, depending on where the individual resides. While enrollees have a range of choices, they typically decide which options best match their needs, the amount of their wages they will contribute to health insurance, and how risk-averse they are to potential out-of-pocket costs. While most federal employees or annuitants reaching age 65 are automatically entitled to Medicare Part A, Medicare-eligible employees may also voluntarily choose to enroll in Medicare Part B and Part D. For individuals covered under a FEHBP plan as an annuitant, Medicare is the primary payer and FEHBP is the secondary payer. As a secondary payer, FEHBP could cover a share of Medicare deductibles and coinsurance for any services that are covered by both plans, and FEHBP would continue to reimburse for its covered services that are not covered by Medicare. FEHBP is administered by the Office of Personnel Management (OPM), which is statutorily given the authority to contract with qualified carriers offering plans and to prescribe regulations necessary to carry out the statute, among other duties. Some of OPM’s additional duties include coordinating the administration of FEHBP with employing offices, managing contingency reserve funds for the plans, and applying sanctions to health care providers according to the prescribed regulations

Improving Health Care Access for Older Alaskans: What Are the Options?

This report focuses on the problem older Alaskans who rely on Medicare face getting access to primary care, and discusses some of the options policymakers are considering to resolve the problem. But older Americans across the country also report difficulty getting the primary care they need. The discussion here sheds light on the problem and potential solutions nationwide. Most Americans 65 and older use Medicare as their primary health insurance. Medicare is federal health insurance for people 65 and older, people under 65 with certain disabilities, and people of any age with end-stage renal disease—but this report looks only at access issues for Medicare beneficiaries 65 and older. Doctors don’t have to participate in the Medicare program. But those who do participate have to accept, as full payment, what Medicare pays for specific services. Many primary-care doctors say Medicare doesn’t pay them enough to cover their costs—so growing numbers are declining to see new Medicare patients. Among primary-care doctors nationwide, 61% accept new Medicare patients.1 National surveys sponsored by the Medicare Payment Advisory Commission have found that 17% of Medicare patients in the U.S. had “a big problem” finding family doctors in 2007—up from 13% in 2005.2 In Alaska, a 2008 survey by the Institute of Social and Economic Research (ISER) found that just over half of Alaska’s primary-care doctors were willing to treat new Medicare patients.3 The situation was worse in Anchorage, where 40% of all older Alaskans live. Only 17% of primary-care doctors in Anchorage were willing to treat new Medicare patients as of 2008 (Figure 1).4The Harold E. Pomeroy Public Policy Research EndowmentIntroduction / How Medicare Works / Closed Doors / Older Anchorage Residents and Primary Care / Options for Changing Access to Primary Care: What is Alaska Considering? / Conclusions / Appendi

Outcomes Assessment and Health Care Reform

Argues for the use of outcomes assessment in measuring cost-effectiveness and quality to capture the overall impact of multi-dimensional treatment strategies and to identify healthcare systems that both adopt appropriate technologies and perform well

Changes in Characteristics, Needs, and Payment for Care of Elderly Nursing Home Residents: 1999 to 2004

Focuses on changes in trends in the population of elderly nursing home residents, including characteristics of their healthcare needs and insurance coverage

Health Care for Dependents and Survivors of Veterans

[Excerpt] The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) was established by the Veterans Health Care Expansion Act of 1973 (P.L. 93 82). CHAMPVA is primarily a health insurance program where certain eligible dependents and survivors of veterans receive care from private sector health care providers. The program is administered by the Veterans Health Administration (VHA), Office of Community Care, located in Denver, CO

Federal Employees Health Benefits (FEHB) Program: An Overview

[Excerpt] The Federal Employees Health Benefits (FEHB) Program provides health insurance to federal employees, retirees, and their dependents. This report provides a general overview of FEHB. It describes the structure of FEHB, including eligibility for the program and coverage options available to enrollees, as well as premiums, benefits and cost sharing, and general financing of FEHB. The report also describes the role of the Office of Personnel Management (OPM) in administering the program

THE CONTRIBUTION OF NORTH DAKOTA'S COMMUNITY PHARMACIES TO THE STATE'S ECONOMY

A pharmacist shortage, mail and internet competition, thinning margins, and third-party payer issues are some of the issues challenging community pharmacies. Those challenges have raised concerns about the long-term viability of independent community pharmacies, especially those in rural areas. In addition to a pharmacy's role in the delivery of prescription drugs, community pharmacies also play an important role in the state and local economies, again, especially in rural communities. Community pharmacies consistently have been classified as a business that provides essential services. Because of the issues and challenges facing community pharmacies and their role as an essential service, this study was undertaken to quantify the economic contribution North Dakota's community pharmacies make to the state's economy and to examine community pharmacies' business characteristics, services provided, and other issues. This study estimates all relevant expenditures and returns associated with North Dakota's community pharmacies.Economic impact, pharmacy, pharmacists, drug stores, Health Economics and Policy,