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The AARP Public Policy Institute focuses on issues of critical importance as we age. Below we highlight research, analysis, background and commentary on Medicare

Recent Analysis

2017 Analysis

Consumer Protections in New Medicare Payment and Delivery Models: A Checklist

This research report identifies and describes a checklist of concrete consumer protections that should be integrated into the design of all Medicare value-based models. Read

Medicare Beneficiaries' Out-of-pocket Spending for Health Care

Many Medicare beneficiaries face significant out-of-pocket expenses to meet their health care needs. In 2013, people with traditional Medicare spent an average of $5,680 on insurance premiums and medical services. One in 10 people on Medicare spent at least $10,852. Health care expenses can create a significant financial burden for many Medicare beneficiaries, with half the people in fee-for-service Medicare spending at least 17 percent of their income on health care. Read

Understanding Medicare's Home Health Benefit

This Spotlight describes Medicare rules for coverage of home health care services. Read

Higher Income Individuals Pay More for Medicare

The Medicare program requires higher-income individuals to contribute more toward the cost of the program than other people. Read

Who Relies on Medicare? A Profile of the Medicare Population

This fact sheet provides 10 key facts about the Medicare population. Read

Premium Support is the Wrong Direction for Medicare: Highlights from a New Research Report

This Insight on the Issues summarizes the key findings from a new Urban Institute research report examining a proposed Medicare reform that would significantly change the program for people with Medicare. The Urban report offers important insights into how transforming Medicare to a “premium support” system would work in practice—and how it would adversely affect people with Medicare. The report—Restructuring Medicare: The False Promise of Premium Support by Robert A. Berenson, Laura Skopec, and Stephen Zuckerman— was funded by the AARP Public Policy Institute. Read

Graham-Cassidy Would Lead to Unaffordable Costs for Older Adults Who Get Sick or Have a Pre-Existing Condition

The Graham-Cassidy bill, as released on September 13, 2017 and circulated on September 24, 2017, would lead to unaffordable increases in health care costs for older adults ages 50-64 who get sick or have a pre-existing condition. Read

Graham-Cassidy Legislation Threatens Affordable Coverage for Older Americans

The Graham-Cassidy (GC) bill threatens to make health care unaffordable and inaccessible for millions of older Americans. Read

Health Insurance Cost-Sharing Reductions Are Critical to Ensuring Affordable Health Care for Older Adults

For over 2 million older adults ages 50-64, subsidies known as cost-sharing reductions are critical financial protection that reduces out-of-pocket health care costs. Read

Spotlight on the Impact of the Graham/Cassidy/Heller/Johnson Bill on Non-Expansion Medicaid Spending in Ten States

New AARP Public Policy Institute fact sheets show the depth of Medicaid cuts proposed by the Graham/Cassidy/Heller/Johnson Bill in Alaska, Arizona, Colorado, Iowa, Maine, Montana, North Dakota, Ohio, Tennessee and West Virginia. Read

Major Threat: How the Better Care Reconciliation Act Jeopardizes Medicaid Home- and Community-Based Services

The Better Care Reconciliation Act (BCRA) puts Medicaid home- and community-based services (HCBS) on the chopping block. The proposed demonstration program for Medicaid HCBS, included in the revised version of the Senate Bill on July 13,  does not change the big picture. According to newanalysis from the AARP Public Policy Institute, states may cut Medicaid HCBS by as much as $46 billion in 2026 to stay within their allotted per capita caps-- a 22 percent cut. Read the new Insight on the Issues to learn more and find out the potential impact on your state. Read

Spotlight on the Impact of the Senate Better Care Reconciliation Act on Total Medicaid Spending

These new fact sheets show the depth of Medicaid cuts proposed by the BCRA in Alaska, Colorado, Nevada, North Dakota, Ohio and West Virginia. Read

Livability Index

How livable is your community?

Impact of the Senate Better Care Reconciliation Act on States

The Senate Better Care Reconciliation Act would make health care unaffordable and inaccessible for millions of Americans. The impacts of the Senate bill on each state are included in this series. Read

Basing Per Enrollee Caps on Historical Medicaid Spending Just Does Not Work

The Better Care Reconciliation Act (BCRA), released by the U.S. Senate, would dramatically change the way the federal government funds Medicaid, likely causing millions of people who currently receive coverage for health care and long-term services and supports (LTSS)—like help with bathing, dressing, eating, wound care and medication management—to lose Medicaid coverage. Read

Under the Health Reform Bill, People with Preexisting Health Conditions Would Face Unaffordable Premiums in State High-Risk Pools

The American Health Care Act (AHCA) would allow states to create high-risk pools where people with preexisting health conditions could go to purchase health insurance. This Fact Sheet shows state-by-state estimates of just how high annual premiums could be in these high-risk pools— ranging from at least $19,330 in Iowa to over $38,600 in Alaska. Nationally, annual premiums in high-risk pools could average at least $25,000. Read

Health Care Bill Harms People with Job-Based Coverage

People who have health insurance coverage through large employers may assume the health care debate won’t affect them. In fact, the American Health Care Act could negatively affect them in several ways. Read

Capped Financing for Medicaid Does Not Account for the Growing Aging Population

New projections from the AARP Public Policy Institute suggest that the AHCA’s per capita cap financing proposal will not keep pace with changing demographics, specifically the growing and aging of the 65+ population. Over time, states will not have adequate funding to serve this vulnerable population under the proposed bill. Read

Impact of the American Health Care Act on States (Updated 6/13/2017)

The American Health Care Act would make health care unaffordable and inaccessible for millions of Americans. The impacts of the bill on each state are included in this series. Read

Impact of Block Grants and Per Capita Caps on Medicaid Enrollees: State Fact Sheets

Changing Medicaid to block grant or per capita cap model could end Medicaid’s guaranteed access to care and shift costs over time to both states and to Medicaid enrollees. What would be the impact on Medicaid in your state? Read

Susan's Blog

Senior Vice President Susan Reinhard blogs about recent reports and topics such as caregiving and nursing.

Adequate Premium Tax Credits are Vital to Maintain Access to Affordable Health Coverage for Older Adults (Updated 3/22/2017)

Over 3 million low- to moderate- income older adults ages 50–64 currently rely on tax credits under the Affordable Care Act (ACA) to purchase health insurance coverage. Proposals to replace the current-law tax credits with new “flat” tax credits adjusted for age would substantially reduce their value by as much as $5,900 for an individual and would put health insurance and care out of reach for many. Read

Experience Has Taught Us That High-Risk Pools Do Not Serve Consumers Well

Recent health reform proposals would allow insurance companies in the individual market to—once again—consider people’s health when deciding whether to sell them coverage. Individuals denied coverage because of a pre-existing condition would likely rely on high-risk pools to access health insurance. In their latest report, PPI’s Lynda Flowers and Claire Noel-Miller describe high-risk pools and highlight their limitations: they were very expensive, they tended to charge high premiums and deductibles, they typically offered limited coverage, and they were not adequately funded—resulting in very low enrollment. Read

Low-Income Medicare Beneficiaries Rely on Medicaid for Critical Help

Medicaid is a lifeline for close to 11 million Medicare beneficiaries. These individuals—called dual eligibles or duals—are the poorest and sickest Medicare beneficiaries.  In this Fact Sheet, PPI’s Jean Accius, Lynda Flowers, and Brendan Flinn discuss how Medicaid benefits duals, describe how Medicare beneficiaries become dually eligible for Medicaid, describe some of the characteristics of duals, and analyze how recent health care reform proposals could harm vulnerable Medicare beneficiaries. Read

The Basics: Medicaid and Long-Term Services and Supports

This Fact Sheet discusses Basic Facts about Medicaid and Long-Term Services and Supports. Read 

In Health Reform, Stakes are High for Older Americans with Preexisting Health Conditions

The Affordable Care Act protects individuals with pre-existing health conditions by prohibiting insurance companies from considering people’s health when they apply for coverage. Without these protections, four out of 10 adults ages 50 to 64 – or about 25 million people in this age group – could be denied health coverage because of a pre-existing condition if they sought to buy an individual plan. Read

Savings Expected from Slowdown in Medicare Spending 

Medicare’s fiscal outlook in the mid and long term is stronger and projected spending is dramatically lower than previously expected. Read

Block Grants and Per Capita caps Pose Risks for Medicaid Beneficiaries and for States

Recent proposals would change the way the federal government pays for the Medicaid program.  This  change could hurt millions of poor seniors and people of all ages with disabilities who rely on Medicaid for needed health care and necessary long-term services and support—like help with eating, bathing, and dressing. Read

Impact of Changing the Age Rating Limit for Health Insurance Premiums

AARP Public Policy Institute released a research report from Milliman that modeled and analyzed the impact of changing the age rating limit for health insurance premiums.  This Spotlight summarizes the findings of the report. Read

Impact of Premium Support on Medicare Beneficiaries: State Fact Sheets

Changing Medicare to a premium support model raises several concerns, including increased costs for beneficiaries. What would be the impact on beneficiaries in your state? Read

Who's Gained Affordable Care Act Coverage with Financial Help?

This Fact Sheet takes a closer look at the 1.4 million adults ages 50-64 who gained health insurance coverage with the assistance of Affordable Care Act (ACA) tax credits. Read

Medicare’s Financial Protections for Consumers: Limits on Balance Billing and Private Contracting by Physicians

The Medicare program protects consumers by limiting how much physicians and other health professionals can charge Medicare patients. This fact sheet describes Medicare’s “balance billing” rules for physician services and related rules for physicians who choose not to accept Medicare payment and instead have “private contracts” with all their patients who have Medicare. Read

Protecting Affordable Health Insurance for Older Adults: The Affordable Care Act’s Limit on Age Rating

As policymakers consider potential changes to the Affordable Care Act (ACA), this fact sheet examines a critical consumer protection for older adults ages 50-64:  the ACA’s 3:1 limit on age rating. Read

Premium Support and the Impact on Medicare Beneficiaries

Under a premium support system, the federal government would replace Medicare beneficiaries’ guaranteed benefit package with a fixed dollar amount or “defined contribution” that beneficiaries would apply toward their health care coverage.  This fact sheet describes the likely impact on Medicare beneficiaries of moving to a premium support system, also known as a defined contribution or voucher system. Read


Changing Medicare into a “Premium Support” Program Would Reduce—Not Increase—Choices for Individuals

The budget blueprint recently passed by the House proposes to redesign Medicare—the program that nearly all Americans ages 65 and older and millions of younger people with disabilities rely on for health coverage. The proposal would transform Medicare into what’s termed a “premium support” or “voucher” program. This change would have a huge impact on people with Medicare today and in the future. Read

Ending Cost-Sharing Reduction Payments Will Hurt Older Adults

Federal subsidies, known as cost-sharing reductions (CSRs), have been critical to ensuring that over 2 million lower-income adults ages 50 to 64 who purchase coverage through health insurance Marketplaces can afford health care. Read

Blog: Graham-Cassidy Would Weaken Protections for Older Adults and People with Preexisting Conditions

A late-breaking attempt to repeal and replace the Affordable Care Act (ACA) threatens to weaken critical federal consumer protections and raise costs for older Americans ages 50-64 who purchase health insurance coverage in the individual market. Tucked into the sweeping legislation known as the Graham-Cassidy bill are provisions allowing states to receive waivers from crucial consumer protections. Read

Blog: Graham-Cassidy Would Weaken Protections for Older Adults and People with Preexisting Conditions

A late-breaking attempt to repeal and replace the Affordable Care Act (ACA) threatens to weaken critical federal consumer protections and raise costs for older Americans ages 50-64 who purchase health insurance coverage in the individual market. Read

Blog: Sounding the Alarm: The New Senate Health Care Bill Could Cut $3.2 Trillion from Medicaid by 2036

The latest Senate health reform bill, known as Graham-Cassidy-Heller-Johnson, puts Medicaid back on the chopping block. The proposal would change the way the federal government currently funds Medicaid by limiting federal funding and shifting cost over time to both states and Medicaid enrollees, and their families. Read

Blog: The Senate Health Reform Bill Slashes Medicaid Severely: Potential Cuts in Eight States

The Better Care Reconciliation Act (BCRA) now under consideration in the Senate would drastically alter Medicaid by limiting federal funding and shifting cost over time to both states and Medicaid enrollees. In a new blog series, the AARP Public Policy Institute projects the impact of the Senate bill’s proposed per capita caps for eight states over twenty years, from 2017-2036. Read

Blog: Under the Senate Health Bill, All Older Adults Would Pay Much More for Individual Health Coverage

The just-released Senate bill, Better Care Reconciliation Act (BCRA), is very bad news for older adults. The bill reduces financial assistance (premium tax credits and cost-sharing subsidies) and changes rules on how much premiums can vary by age (age-rating). As a result, people ages 50 to 64 would have to pay thousands of dollars more in premiums to buy health insurance in the individual (non-group) market. Read

Blog: CMS Report Confirms Medicaid Cuts Would Jeopardize Critical Services and Long-Term Program Stability

The proposed American Health Care Act (AHCA) would make significant changes to the Medicaid program, which serves as a critical safety net for millions of people who deplete their life savings and turn to Medicaid for assistance as their ability to care for themselves declines. Read

Blog: Stability Fund Won’t Keep Premiums From Going Through the Roof for People With Preexisting Conditions

The American Health Care Act (AHCA), H.R.1628, allows states to create high-risk pools for people with preexisting health conditions under certain circumstances. Read

Blog: The American Health Care Act Would Make Unsustainable Cuts to Medicaid

Recent policy conversations related to the American Health Care Act (AHCA) have focused on  proposals that would eliminate the Affordable Care Act’s critical protection for people with preexisting conditions. This controversial proposal has drawn a lot of attention for good reason. Read

Blog: Protecting People with Preexisting Conditions: Upton Amendment, as Reported, is Not Enough to Get the Job Done

The Upton Amendment to the health care bill, American Health Care Act (AHCA), is not sufficient to protect people with preexisting health conditions. Read

Blog: MacArthur Amendment to AHCA Would Mean Higher Premiums for Age and Preexisting Conditions

We already know that health insurance legislation known as the American Health Care Act (AHCA) is a bad deal for older Americans ages 50-64. For people who purchase coverage on their own in the individual (nongroup) market and are not yet eligible for Medicare, the bill would significantly increase premiums for all older adults and spike costs dramatically for lower- and moderate-income older adults. Read

Blog: State High-Risk Pools Failed Consumers in the Past — and Would Again

The revised American Health Care Act (AHCA) threatens to do away with the Affordable Care Act’s (ACA) protections for people with preexisting health conditions. These protections prevent insurance companies from denying these individuals coverage or charging them higher rates based on their health. Read

Blog: The Fierce Urgency of Now: How $880 Billion in Cuts to Medicaid Could Hurt Us All

If you have protection against future catastrophic out-of-pocket costs for basic life functions, consider yourself lucky. The vast majority of people in the United States don’t. Read

Blog: Proposed Tax Credits Raise Affordability Concerns for Older Adults

Did you know that over 3 million older adults ages 50-64 rely on Affordable Care Act (ACA) tax credits to purchase health coverage? In fact, pre-ACA, almost half of them were uninsured. Read

Blog: Capping Medicaid Funding Could Hurt Millions of People With Disabilities and Poor Seniors

Medicaid is the country’s largest public health insurance program, providing access to needed health care and long-term services and supports  (LTSS) to millions of low-income Americans, including more than 17 million children with disabilities, adults with disabilities, and poor seniors. Read

Blog: Protecting Affordable Health Insurance Premiums for Older Adults

The Affordable Care Act (ACA) established a 3-to-1 limit on age rating of health insurance premiums, meaning that older adults who purchase coverage on their own cannot be charged more than three times the amount a younger person is charged for the same health plan. Read

Blog: Closing the ‘Doughnut Hole’ Has Protected Millions of Medicare Beneficiaries From High Drug Costs

Since 2006, Medicare beneficiaries have had access to outpatient prescription drug coverage through Medicare Part D. The standard benefit under Part D includes an annual deductible, an initial coverage period when enrollees pay 25 percent of their drug costs, and catastrophic coverage that limits enrollees’ spending to roughly 5 percent of their drug costs. Read

Blog: The Ban on Preexisting Condition Exclusions Helps Older Adults

Most Americans get their health insurance through their employer or through government-sponsored programs like Medicare or Medicaid. People who do not have access to those forms of coverage — for instance, because they are between jobs or are self-employed — typically buy health insurance directly from private insurers on the individual market. Read

Analysis Prior to 2017

Rx Price Watch Report: Trends in Retail Prices of Brand Name Prescription Drugs Widely Used by Older Americans: 2006 to 2015

The latest Rx Price Watch report by Leigh Purvis and Dr. Stephen Schondelmeyer finds that retail prices for widely used brand name prescription drugs increased substantially faster than general inflation between 2006 and 2015, and that the difference between the rate of brand name drug price increases and the rate of general inflation has been widening. Read

Monitoring the Impact of Health Reform

New data from the Urban Institute and the AARP Public Policy Institute show that insurance coverage for 50- to 64-year-olds has improved significantly under the Affordable Care Act (ACA). Read

Trends in Retail Prices of Specialty Drugs

New Rx Price Watch Report finds that the average annual cost for a specialty drug exceeded the median U.S. family income in 2013. Read

Medicare Beneficiaries' Out-of-Pocket Spending for Health Care

Half of all Medicare beneficiaries in the fee-for-service program spent at least $3,595 of their own money on health care in 2011. Read

Medicare Part B Premiums and Deductible in 2016: The Effect of No Cost-of-Living Increase in Social Security Benefits

This fact sheet describes what will happen to next year’s Medicare Part B premiums—and how that will affect Medicare enrollees and states—as a result of no Social Security cost-of-living adjustment  for 2016.Read

Work and Health Insurance for 50- to 64-Year-Olds

Part-time workers and the self-employed are much less likely than full-time workers to have insurance through their employment.  Read

Effect of Health Reform for 50- to 64-Year-Olds

What do the reforms in the Affordable Care Act (ACA) mean for 50- to 64-year-olds? Read

Who Relies on Medicare?

Ten key facts about the Medicare population. Read

The Medicare Program: a Brief Overview

Basic facts about what Medicare covers, how the program is financed and how much it spends. Read

Options for Reforming Medicare

National experts discuss a range of perspective on leading proposals to reform Medicare. Read

Higher-Income Individuals Pay More for Medicare

Higher-income individuals contribute more toward the cost of the program than the general population. Read

Medicare Beneficiaries’ Out-of-Pocket Spending for Health Care

This report assesses the out-of-pocket spending burden on beneficiaries enrolled in traditional Medicare. Read

How Does Medicare Compare?

Benefits and cost sharing: How does Medicare compare with typical large employer health plans? Read

Medicare Part D Open Enrollment for 2014: Popular Plans Continue to Evolve

Premiums for many popular Part D plans are noticeably higher in 2014. Read

Past Events