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Issue Brief
  1. This provision was included in the Social Security Amendments of 1972, with Medicare coverage effective July 1, 1973.

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  2. Centers for Medicare & Medicaid Services (CMS), Office of Enterprise Data and Analysis, Office of the Actuary, CMS Fact Facts, available at https://www.cms.gov/fastfacts/.

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  3. CMS, 2013 Medicare & Medicaid Statistical Supplement, Table 2.1 Medicare Enrollment: Hospital Insurance and/or Supplementary Medical Insurance Programs for Total, Fee-for-Service and Managed Care Enrollees as of July 1, 2012: Selected Calendar Years 1966-2012.

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  4. In 2014, 4.5 million people on Medicare age 65 or older (10% of all beneficiaries age 65 or older) initially qualified for Medicare due to receiving disability insurance benefits, having end-stage renal disease, or both prior to turning age 65; based on Kaiser Family Foundation analysis of a five percent sample of 2014 Medicare claims from the CMS Chronic Conditions Data Warehouse.

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  5. In 2014 0.3 million people on Medicare under age 65 (3% of all beneficiaries under age 65) qualified for Medicare due to having ESRD (separate estimates for ALS are not available); based on Kaiser Family Foundation analysis of a five percent sample of 2014 Medicare claims from the CMS Chronic Conditions Data Warehouse.

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  6. U.S. Social Security Administration, Office of Retirement and Disability Policy, Office of Research, Evaluation, and Statistics, Annual Statistical Report on the Social Security Disability Insurance Program, 2014, November 2015, Table 6: Beneficiaries in Current-Payment Status, Distribution, by sex and diagnostic group, December 2014, available at: http://www.socialsecurity.gov/policy/docs/statcomps/di_asr/2014/.

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  7. We scaled respondents’ income estimates reported in the Medicare Current Beneficiary Survey to match income distribution estimates from The Urban Institute’s 2012 Dynamic Simulation of Income Model (DYNASIM).

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  8. This applies to Medicare beneficiaries residing in the community; for facility residents, the definition of cognitive/mental impairment also includes ability to recall names and faces, current season, location of nursing home, and room.

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  9. We assign supplemental coverage in the following order: Medicare Advantage, Medicaid, employer, Medigap, other, none. Beneficiaries with multiple sources of coverage are assigned to the highest category in the ordering.

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  10. Our methodology of assigning supplemental coverage in a hierarchical manner understates the share of beneficiaries with Medicaid, since those who also have Medicare Advantage are included in that coverage group. In 2012, a total of 45% of beneficiaries under age 65 with disabilities and 14% of beneficiaries age 65 or older were dually-eligible for Medicare and Medicaid.

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  11. See https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html; see also Kaiser Family Foundation, “Medigap: Spotlight on Enrollment, Premiums, and Recent Trends,” April 2013, available at http://kff.org/medicare/report/medigap-enrollment-premiums-and-recent-trends/.

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  12. Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2013 Access to Care file.

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  13. Analysis of per capita Medicare and out-of-pocket spending among beneficiaries enrolled in Medicare Advantage plans is not possible due to lack of or insufficient data.

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  14. Juliette Cubanski, Tricia Neuman, and Anthony Damico, “Similar But Not the Same: How Medicare Per Capita Spending and Service Use Compares for Younger and Older Beneficiaries,” Kaiser Family Foundation, August 2016, available at http://kff.org/medicare/issue-brief/similar-but-not-the-same-how-medicare-per-capita-spending-compares-for-younger-and-older-beneficiaries.

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  15. Analysis of service use among beneficiaries enrolled in Medicare Advantage plans is not possible due to lack of data.

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  16. Irrespective of the supplemental coverage hierarchy, these estimates are 45% and 14%, respectively. See endnotes 9 and 10.

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  17. Juliette Cubanski and Tricia Neuman, “Medicare Doesn’t Work As Well for Younger, Disabled Beneficiaries As It Does for Older Enrollees,” Health Affairs, September 2010, vol. 29 no. 9 1725-1733.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.