download .ppt
TRANSCRIPT
Return to KaiserEDU Tutorials
Health Care and Long-term Care Policy:Concerns Facing Older Women
Alina Salganicoff, Ph.D.
Vice President and Director, Women’s Health Policy
Kaiser Family Foundation
August 2008
Figure 1
Return to KaiserEDU Tutorials
Medicare matters for older women
• Medicare is a federal health insurance program designed for the elderly and people with disabilities
• Covers 44 million people– 37 million people ages 65 and over, and 7 million under age 65
with a permanent disability
• Most major health care services covered– Hospital stays
– Physician visits
– Preventive care, including annual screenings
– Medical supplies, and other ancillary services
– Prescription drugs (through private plans)
Figure 2
Return to KaiserEDU Tutorials
Women comprise the majority of Medicare enrollment
56% 48% 54% 58%70%
46% 42%52%
44%30%
Total <65 65-74 75-84 85+
Men
Women
Source: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey Access to Care file, 2006.
Number of Beneficiaries 39.8 million 6.3 million 16.3 million 12.5 million 4.7 million
Figure 3
Medicare beneficiaries, by Age and Sex, 2006
Return to KaiserEDU Tutorials
How does Medicare work?
• Part A: Covers inpatient hospital care, skilled nursing facility care (following hospitalization), hospice care, and limited home health services (up to 100 days post-hospital)
• Part B: Supplementary Medical Insurance program helps pay for Physician services, outpatient hospital care, preventive services, such as mammography screening, mental health services, home health, and x-rays, diagnostic tests, durable medical equipment
• Part C: Provides care through managed care plans, such as local HMOs, new regional PPOs, private fee-for-service plans, and is referred to as Medicare Advantage
• Part D: Medicare prescription drug benefit, which are private plans that contract with Medicare. These include stand-alone prescription drug plans and Medicare Advantage plans that also include the Part D benefit.
Figure 4
Return to KaiserEDU Tutorials
Medicare costs and gaps
• Benefit gaps– No hearing aids, eyeglasses, or dental care– Limited long-term care
• Significant cost-sharing requirements– Part A deductible ($1,024 in 2008)– Part B monthly premium ($96.40/month in 2008)
• Most preventive services have cost-sharing requirement• 20% coinsurance for mammography, CBE, Bone Mass, Pap test (no
charge for lab)
– Part D - Medicare drug plans charge various premiums, deductibles, co-payments
– No cap on out-of-pocket spending
• Medicare paid for 48% of total covered health and long-term care costs in 2005; beneficiaries paid 18% out-of-pocket
Figure 5
Return to KaiserEDU Tutorials
Supplemental health insurance coverage
42%
20%
14%7%
22% 20%
8% 11%
35%
21%
1%2%
None
Other Public/Private
Self-purchased
Medicaid
Medicare Advantage
Employer-sponsored
Men 65 and OlderN = 14.3 million
Women 65 and OlderN = 19.2 million
Source: Kaiser Family Foundation analysis of Medicare Current Beneficiary Survey Access to Care file, 2006.
Figure 6
Return to KaiserEDU Tutorials
Medicaid matters for older women
• Medicaid—a federal/state health insurance program or low-income families, elderly, and disabled
– Covers 55 million people, including 6 million people age 65 and older
– Elderly account for 11% of Medicaid enrollees but 28% of overall spending
• Covers benefits not included in Medicare– Vision, dental, and hearing services, differs by state
– Long-term care services
– Pays for Medicare premiums, deductibles, coinsurance and copays
• Eligibility is limited to very low income/disabled elderly– Incomes below 100% of poverty
– Others must spend-down or deplete their income and assets to become eligible
– Some low-income Medicare beneficiaries who are not poor enough to qualify for full Medicaid benefits can get Medicaid assistance for Medicare cost-sharing
Figure 7
Return to KaiserEDU Tutorials
Many older women on Medicare are impoverished
43%
27%
43%
19%
16%
15%65 to 74
75 to 84
85 & Older
Age
Race/Ethnicity
White
African American
Latina
Percent of women ages 65 and older on Medicare with annual income below $10,000:
Source: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey Access to Care file, 2006.
Figure 8
Return to KaiserEDU Tutorials
64% 71%81%
36% 29%19%
65 to 74 75 to 84 85 and older
Women Men
Older women comprise the majority of seniors on Medicaid
Source: Kaiser Commission on Medicaid and the Uninsured and Urban Institute analysis of 2004 MSIS data, 2007.
Women = 70% of the 5.9 million Medicaid beneficiaries 65 and older
Distribution of Seniors with Medicaid, by Age and Sex, 2004
Figure 9
Return to KaiserEDU Tutorials
$653 $545
$866 $789
$1,070$699
$1,731
$1,718
$275$157
Premiums
Long-term care:nursing home; SNF;home health Medical/dental visits;supplies
Prescription drugs
Inpatient/outpatienthospital visits
Note: Estimates reflect mean out-of-pocket spending for Medicare and private insurance premiums and health care services. Source: KFF analysis of the CMS Medicare Current Beneficiary Survey Cost and Use File, 2005.
Women 65+Women 65+
Total OOP = $94 billionTotal OOP = $94 billion
Men 65+Men 65+
Total OOP = $63 billionTotal OOP = $63 billion
$4,476$4,476
$4,026$4,026
Out-of-pocket health spending by Medicare beneficiaries age 65+, 2005
39%
43%
17%
20%
14%
7%
24%
19%
15%
4%
Figure 10
Return to KaiserEDU Tutorials
Women comprise the majority of the long-term care population
Nursing Home Residents
Home Health Users
Total = 1.5 million Total = 2.5 million
Source: Kaiser Family Foundation analysis of Medicare Current Beneficiary Survey Access to Care file, 2006.
Figure 11
Men32%
Women68%
Men24%
Women77%
Return to KaiserEDU Tutorials
Many older women have limitations that predispose them to needing long-term care
23%
15%
17%
9%
11%
17%
Cognitive/MentalImpairment
Limitations in2+ IADLs
Limitations in2+ ADLs
Men
Women
Note: ADLs refer to Activities of Daily Living (bathing, dressing, eating, walking, using the toilet, getting in and out of chairs). IADLs refer to Instrumental Activities of Daily Living (doing housework, making meals, managing money, shopping, using the telephone). Analysis excludes institutional population.Source: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey Access to Care file, 2006.
30%
16%
30%
21%
11%
23%
16%
17%
15%
5%
21%
11%
12%
10%
2%
Cognitive/MentalImpairment
Limitations in 2+IADLs
Limitations in 2+ADLs
Incontinence
Broken Hip65 to 74
75 to 84
85 & Over
By Sex: Women, by Age:
Figure 12
Return to KaiserEDU Tutorials
Economic and social factors also affect long-term care use for women
17%
46%39%
49%
9%14%
19%
28%
Age 85+ Widowed Living alone Income less than$20,000/yr
Women Men
Figure 13
Source: KFF analysis of Medicare Current Beneficiary Survey, 2006
Return to KaiserEDU Tutorials
Long-term care services are costly
In 2008:– Home health services
average $29/hour
– Homemaker services average $18/hour
– Adult Day Care average $59/day
$76,285$68,985
$36,096
Nursing HomeCare - private
Nursing HomeCare - semi-
private
Assisted Living -one bedroom
Average annual cost
Source: National Clearinghouse for Long-Term Care Information, U.S. Department of Health and Human Services, 2008
Figure 14
Return to KaiserEDU Tutorials
Medicaid is a major payer of long-term care
Medicaid50%
Out-of-pocket18%
Private insurance7%
Medicare20%
Other public/private5%
Source: National Clearinghouse for Long-Term Care Information, U.S. Department of Health and Human Services, 2008
Figure 15
Total long-term care expenditures in 2005 = $206.6 billion
Return to KaiserEDU Tutorials
Coverage and cost challenges for older women
• Women have fewer financial resources: Social Security, pensions, and assets
• Medicare out-of-pocket costs can be burdensome
• Long-term care coverage limited– Medicare and home care– Medicaid and nursing home care
Figure 16
Return to KaiserEDU Tutorials
For more resources
• KaiserEDU – Medicare – Women’s Health Policy– Medicaid/SCHIP
• Kaiser Family Foundation– Medicare– Women’s Health Policy– Kaiser Commission on Medicaid and the Uninsured
• Centers for Medicare and Medicaid Services
Figure 17