title: Medicare essential: an option to promote better care and curb spending growth.
abstract: Medicare's core benefit design reflects private insurance as of 1965, with separate coverage for hospital and physician services (and now prescription drugs) and no protection against catastrophic costs. Modernizing Medicare's benefit design to offer comprehensive benefits, financial protection, and incentives to choose high-value care could improve coverage and lower beneficiary costs. We describe a new option we call Medicare Essential, which would combine Medicare's hospital, physician, and prescription drug coverage into an integrated benefit with an annual limit on out-of-pocket expenses for covered benefits. Cost sharing would be reduced for enrollees who seek care from high-quality low-cost providers. Out-of-pocket savings from lower premiums and health care costs for a Medicare Essential enrollee could be $173 per month, compared to what an enrollee would pay with traditional Medicare, prescription drug and private supplemental coverage. Financed by a budget-neutral premium, we estimate that this new plan choice could reduce total health spending relative to current projections by $180 billion and reduce employer retiree spending by $90 billion during 2014-23. Given its potential, such an alternative should be a part of the debate over the future of Medicare.
authors: Department of Health Policy and Management, Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. kadavis@jhsph.edu
authors: Karen
authors: K
authors: Davis
authors: Cathy
authors: C
authors: Schoen
authors: Stuart
authors: S
authors: Guterman
mesh_terms: D003363:Cost Control / Q000191:economics / Q000379:methods / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D005380:Financing, Government / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D005382:Financing, Personal / Q000191:economics / Q000458:organization & administration; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000458:organization & administration; D017054:Insurance, Medigap / Q000191:economics / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics / Q000458:organization & administration*; D011203:Poverty / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics / Q000458:organization & administration; D014481:United States
keywords: Access To Care; Cost Of Health Care; Elderly; Health Reform; Medicare