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Medicare Reform Strategy Floated by House Committees

Margaret Dick Tocknell, for HealthLeaders Media, September 3, 2013

According to the paper, it is time for Medicare to follow the lead of commercial insurers, which have long coordinated hospital and physician benefits. Medicare continues to relay on "an array of confusing coinsurance and deductible levels and a fee-for-service structure," that have discouraged provider care coordination, rewarded overutilization, and increased costs.

The paper makes these suggestions:

  • Uniform deductible. Set a combined annual deductible for Medicare Part A (hospital, skilled nursing, and home health services) and Medicare Part B (physician and outpatient services) to "better align beneficiary incentives."
  • Coinsurance. Put in place a simplified coinsurance rate that applies to spending above the uniform deductible to help make out-of-pocket costs more predictable for a beneficiary.

In addition, there is a call for reforms to protect Medicare beneficiaries from out-of-pocket costs that "exceed a defined and reasonable catastrophic limit."

The discussion paper also notes that any reform proposals must take into account how the purchase of supplemental coverage, including so-called Medigap policies and employer-sponsored retiree plans, may impact overall Medicare costs.

A 2009 MedPAC study found that overall Medicare spending was 33% higher when beneficiaries had Medigap insurance and 17% higher when they had employer-sponsored coverage.

No time line for additional discussion papers, committee hearings, or reform bills has been given.


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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