HIMSSCast: Revolutionizing the Medicare program 

 HIMSSCast: Revolutionizing the Medicare program 

Photo: Tetra/Getty Images

Brookings Institution Visiting Fellow Wendell Primus spent 18 years working on Capitol Hill as a senior policy advisor on health and budget issues for former House Speaker Nancy Pelosi.

Now with Brookings Institution Research Assistant Parish Rich Bingham, Primus has published a white paper, “Reducing premiums for low-income Medicare beneficiaries.”

Their research is striking, Primus said, because it shows a large disparity between what low-income Medicare beneficiaries pay for premiums and what Affordable Care Act beneficiaries with the same income pay.

ACA plan members whose income is no more than 150% of the federal poverty level pay zero in premiums, while an elderly single individual with the same income is paying $2,500 in premiums a year and a couple is paying over $5,000 a year in premiums.

“The evidence is very clear here. There is a big disparity between what Affordable Care Act beneficiaries pay and Medicare beneficiaries with the same income and family size,” Primus said. “For two federal programs, that’s a large disparity.”

For Primus’ solution, listen to his conversation with Susan Morse, executive editor of Healthcare Finance News.


Talking points: 

  • For low-income Medicare individuals, $2,500 in premiums a year represents 11.5% of income.
  • The cost for both original Medicare beneficiaries and those who have a Medicare Advantage plan is about the same, he said.
  • Medicare Advantage beneficiaries get a break on Part D coverage, but not on Part B, which is $174,70 a month.
  • Primus’ plan would reduce premiums for more than 26 million beneficiaries and increase premiums for the 9% who are the richest Medicare beneficiaries.
  • The “expensive proposition” would cost $40-$45 billion per year.
  • Premiums in Medicare have to cover 25% of the cost of the program.
  • Under the paper’s proposal, higher income beneficiaries would pay an amount to equal 50% of program costs.
  • The plan would require legislation. The disparity is so large, something will happen, even if it’s not his proposal, Premus said.

More about this episode:

Medicare households spend more on healthcare, report finds

Medicare beneficiaries to receive Part D out-of-pocket cap

HHS seeks to streamline marketplace coverage, health benefits

Deceptive Medicare marketing draws ire of low-income seniors

Healthcare affordability is a top voter issue in the 2024 presidential election

Email the writer: SMorse@himss.org

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