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Medicare and Means Testing

V I E W P O I N T

Congressional deliberations about how to reduce federal Medicare spending, or how to pay for other priorities, include proposals for further means testing Medicare - that is, requiring higher-income beneficiaries to pay more of Medicare's costs.

Medicare premiums are already income related.  Medicare beneficiaries with incomes above $85,000 for individuals and $170,000 for couples are paying higher Part B and D premiums due to provisions in the Medicare Modernization Act of 2003 (MMA) and the Affordable Care Act (ACA). In addition, beginning this year, beneficiaries with incomes above $133,500 are paying higher premium subsidies than were previously scheduled due to a provision in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. In 2018, higher-income beneficiaries are paying premiums ranging from $187.50 to $428.60 per month, depending on their level of income, compared with the standard premium of $134.00. Extra Part D premiums range from $13.00 to $74.80 above the $35.02 national base beneficiary premium. The higher premiums range from 35 percent to 80 percent of Part B and D spending, compared with the standard monthly premium that covers 25 percent. 

Increasing means testing reaches far down into the middle class.  The income thresholds for income-related premiums are frozen under current law until 2019, meaning a greater proportion of beneficiaries are affected each year. It is estimated that the number of Medicare beneficiaries subjected to higher premiums will increase from 3.5 percent in 2011 to 7 percent in 2017 to a projected 8.3 percent in 2019.[1] Some in Congress and the Administration have proposed increasing means testing until 25 percent of beneficiaries are subject to higher premiums. A study from the Kaiser Family Foundation found that this would affect individuals with incomes equivalent to $45,600 for an individual and $91,300 for a couple in 2014[2] – meaning it would reach many middle-income Americans. Means testing could also increase costs for middle and lower-income seniors if higher-income seniors, who are often younger and healthier, are driven away from Medicare by increased cost sharing. This would undermine the over 52 years of success with this social insurance model.

Wealthy individuals already pay more.  The Medicare Hospital Insurance (Part A) Trust Fund is financed with payroll taxes of 1.45 percent on employees, matched by employers, with self-employed individuals paying the full 2.9 percent. Since 1994, this payroll tax has been levied on all covered wages and self-employment without a payroll cap like Social Security. Therefore, the higher an individual's earnings, the more he or she will contribute to Medicare Part A during their working years. In addition, the Part A payroll tax increased in 2013 by an additional 0.9 percent on taxpayers earning above $200,000 for an individual and $250,000 for a couple. These same income thresholds also trigger a 3.8 percent surtax on unearned income, such as interest, dividends and capital gains, which is applied to Medicare.

 NATIONAL COMMITTEE POSITION

  • We oppose means testing in general, and we oppose the proposal that was made in Congress to require some Medicare beneficiaries to pay 100 percent of their Part B premium. 

  • Additional means testing would undermine the social insurance nature of Medicare and ultimately raise costs for middle and lower-income seniors who depend on it.

  • If mean-testing results in Medicare becoming increasingly unfair to higher-income beneficiaries, they may opt out and purchase their own policy on the private market. The departure of higher-income beneficiaries, who tend to be younger and healthier, would increase overall costs and reduce public support for the program.

  • Over the past decade Medicare spending per enrollee has grown more slowly than private health insurance spending. Medicare’s costs are increasing due to overall health care inflation and the increase in the number of Medicare beneficiaries as the baby-boom generation ages into the program.

  • Proposals which shift costs to beneficiaries, such as means testing and increasing the age of eligibility, create savings for the federal government by shifting costs onto middle-class beneficiaries. They do nothing to reign in overall health care spending.

We recognize the need to reduce federal health care spending and support proposals, such as building on the cost savings and efficiencies in the Affordable Care Act and requiring rebates for prescription drugs used by individuals dually eligible for Medicare and Medicaid, which do not shift costs to beneficiaries.

 

Government Relations and Policy, January 2018



[1] Juliette Cubanski and Tricia Neuman, “Medicare’s Income-Related Premiums: A Data Note,” Kaiser Family Foundation, Washington, DC, June 2015, https://www.kff.org/medicare/issue-brief/medicares-income-related-premiums-a-data-note/.

[2] Juliette Cubanski, Tricia Newman, Gretchen Jacobson and Karen E. Smith, “Raising Medicare Premiums for Higher-Income Beneficiaries:  Assessing the Implications,” Kaiser Family Foundation, Washington, DC, January 2014, https://kaiserfamilyfoundation.files.wordpress.com/2014/01/8276-02-raising-medicare-premiums-for-higher-income-beneficiaries.pdf


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