Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond
| Table 1: Comparison of Budgetary Effects of Options to Add an Annual Out-of-Pocket Spending Limit to Medicare, Assuming Full Implementation in 2021 | |||||||
| Budget Effects (in billions) | |||||||
| Out-of-pocket spending limit | Limit applies to | Net change in Medicare liability for Part A/B services | Net change in total Medicaid liability | Net change in federal Medicaid liability | Net change in state Medicaid liability | Total Federal Budget Effects in 2021 | Total 10-Year Federal Budget Effects (2020-2029) |
| $5,000 | Beneficiary OOP | $6.0 | -$0.8 | -$0.4 | -$0.3 | $8.3 | $114.1 |
| Beneficiary OOP and Medicaid | $12.5 | -$5.9 | -$3.4 | -$2.5 | $15.0 | $205.5 | |
| All non-Medicare spending | $19.4 | -$6.0 | -$3.5 | -$2.5 | $24.6 | $332.9 | |
| $6,700 | Beneficiary OOP | $3.8 | -$0.5 | -$0.3 | -$0.2 | $5.4 | $74.1 |
| Beneficiary OOP and Medicaid | $9.2 | -$4.6 | -$2.7 | -$1.9 | $10.9 | $150.3 | |
| All non-Medicare spending | $14.7 | -$4.8 | -$2.8 | -$2.0 | $18.6 | $253.5 | |
| Income-related (% of FPL): 0-150%: $3,350 151-800%: $6,700 801-900%: $7,500 901-1,000%: $8,500 1,001%+: $9,500 |
Beneficiary OOP | $5.9 | -$1.0 | -$0.6 | -$0.4 | $8.2 | $118.7 |
| Beneficiary OOP and Medicaid | $13.9 | -$7.3 | -$4.2 | -$3.1 | $16.2 | $228.0 | |
| All non-Medicare spending | $20.0 | -$7.5 | -$4.3 | -$3.1 | $24.7 | $345.1 | |
| NOTE: OOP is out-of-pocket. FPL is federal poverty level. SOURCE: KFF summary of Medicare benefit modeling data from Actuarial Research Corporation. |
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| Table 2: Eligibility for Medicare Savings Programs in 2020 | |||||||
|
Beneficiary Group |
Level of Medicaid Benefits | FPL Threshold | Monthly Income Limit | Asset Limit | Benefits | ||
| Individual/ Married | Individual/ Married | Part A Premiums | Part B Premiums | Part A & B Cost sharing | |||
| Qualified Medicare Beneficiary (QMB) | |||||||
| QMB-plus | Full | ≤100% | $1,084/ $1,457 |
$2,000/ $3,000 |
√ | √ | √ |
| QMB-only | Partial | ≤100% | $1,084/ $1,457 |
$7,860/ $11,800 |
√ | √ | √ |
| Specified Low-Income Medicare Beneficiary (SLMB) | |||||||
| SLMB-plus | Full | 101-120% | $1,296/ $1,744 |
$2,000/ $3,000 |
√ | √ | |
| SLMB-only | Partial | 101-120% | $1,296/ $1,744 |
$7,860/ $11,800 |
√ | ||
| Qualifying Individual (QI) | |||||||
| QI | Partial | 121-135% | $1,456/ $1,960 |
$7,860/ $11,800 |
√ | ||
| Qualified Disabled and Working Individuals (QDWI) | |||||||
| QDWI | Partial | ≤200% FPL* | $4,339/ $5,833 |
$4,000/ $6,000 |
√ | ||
| NOTE: FPL is federal poverty level. Alaska and Hawaii have higher income eligibility limits. Income limits include $20 monthly income disregard. Resource limits do not include $1,500 for burial expenses. *QDWI income thresholds are based on 200% of FPL and do not count half of income earned from work. Full-benefit dually eligible beneficiaries qualify for full Medicaid benefits and receive financial assistance through the Medicare Savings Programs. Partial-benefit dually eligible beneficiaries receive only financial assistance through the Medicare Savings Programs, but do not receive full Medicaid benefits. SOURCE: KFF summary of information from National Council on Aging, “Medicare Savings Programs Eligibility and Coverage Chart, 2020,” updated March 2020; Medicaid and CHIP Payment and Access Commission, “Report to Congress on Medicaid and CHIP, Chapter 3: Improving Participation in the Medicare Savings Programs,” June 2020. |
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| Table 3: Eligibility for Medicare Savings Programs (MSPs) in States with Different Income and/or Asset Limits than Federal Limits in 2020 | ||||
| State | Monthly Income Limit | Asset Limit | ||
| QMB | SLMB | QI | ||
| United States | $1,084/ $1,457 | $1,296/ $1,744 | $1,456/ $1,960 | $7,860/ $11,800 |
| Alabama | Same as federal | No limit | ||
| Arizona | Same as federal | No limit | ||
| Connecticut | $2,245 / $3,032 | $2,458 / $3,319 | $2,617 / $3,535 | No limit |
| Delaware | Same as federal | No limit | ||
| DC* | $3,190/ $4,310 | N/A* | N/A* | No limit |
| Illinois | Same as federal plus $25 disregard | Same as federal | ||
| Indiana | $1,615 / $2,175 | $1,827 / $2,463 | $1,987 / $2,678 | Same as federal |
| Louisiana | Same as federal | No limit | ||
| Maine | $1,670 / $2,255 | $1,882 / $2,543 | $2,043 / $2,758 | $58,000 / $87,000 |
| Massachusetts | $1,402 / $1,888 | $1,615 / $2,176 | $1,774 / $2,391 | $15,720 / $23,600 |
| Minnesota | Same as federal | $10,000 / $18,000 | ||
| Mississippi | Same as federal plus $50 disregard | No limit | ||
| New York | Same as federal | No limit | ||
| Oregon | Same as federal | No limit | ||
| Vermont | Same as federal | No limit | ||
| NOTE: QMB is Qualified Medicare Beneficiary. SLMB is Specified Low-Income Medicare Beneficiary. QI is Qualifying Individual. Monthly income includes $20 monthly income disregard, except in those states that have higher income disregards or no disregard: CT includes no standard disregard; ME increased income disregard to $75 for single and $100 for couples. Maine’s asset limits apply to liquid assets only. *QMB is the sole program in DC. SOURCE: KFF summary of information from National Council on Aging, “Medicare Savings Programs Eligibility and Coverage Chart, 2020,” updated March 2020; Medicaid and CHIP Payment and Access Commission, “Report to Congress on Medicaid and CHIP, Chapter 3: Improving Participation in the Medicare Savings Programs,” June 2020. |
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| Table 4: Eligibility for Part D Low-Income Subsidy (LIS) Program in 2020 | |||||||||
| Beneficiary Group | Monthly Income Limit | Asset Limit | Premium | Cost Sharing | |||||
| Individual/ Married | Individual/ Married | Deductible | Initial Coverage | Catastrophic | |||||
| Full Low-Income Subsidy | |||||||||
| Full-benefit duals | income ≤100% FPL | State Medicaid/ MSP | State Medicaid/ MSP | $0 | $0 | $1.30 generic; $3.90 brand | $0 | ||
| income >100% FPL | State Medicaid/ MSP | State Medicaid/ MSP | $0 | $0 | $3.60 generic; $8.95 brand | $0 | |||
| Non-full-benefit duals (QMB-only, SLMB-only, QI) OR non-duals | income ≤135% FPL & lower asset levels | $1,456/ $1,960 | $7,860/ $11,800 | $0 | $0 | $3.60 generic; $8.95 brand | $0 | ||
| Partial Low-Income Subsidy | |||||||||
| Non-duals | income ≤135% FPL & higher asset levels | $1,456/ $1,960 | $7,860 to $13,110/ $11,800 to $26,160 | $0 | $89 | 15% coinsurance | $3.60 generic; $8.95 brand | ||
| income between 135%-150% FPL | $1,615/ $2,175 | $13,110/ $26,160 | Scaled | $89 | 15% coinsurance | $3.60 generic; $8.95 brand | |||
| NOTE: FPL is federal poverty level. Alaska and Hawaii have higher income eligibility limits. Income limits include $20 monthly income disregard. Resource limits do not include $1,500 for burial expenses. SOURCE: KFF summary of information from National Council on Aging; “Part D LIS/Extra Help Eligibility and Coverage Chart, 2020” updated January 2020; Centers for Medicare & Medicaid Services, “Letter to All Part D Plan Sponsors: 2020 Resource and Cost-Sharing Limits for Low-income Subsidy (LIS),” November 1, 2019. |
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