Public Policy and Health Care Choices of the Elderly: Evidence from the Medicare Buy-In Program

Aaron Yelowitz

Institute for Research on Poverty Discussion Papers from University of Wisconsin Institute for Research on Poverty

Abstract: This study provides evidence on the economic decisions of senior citizens with respect to the largest means-tested program in the United States: the Medicaid program. Virtually all senior citizens have health insurance coverage through Medicare, but poor seniors may also be eligible for Medicaid, which fills in many of the gaps in Medicare coverage. Since 1987, the Medicaid program has undergone a series of changes relating to eligibility. In particular, two new categories of elderly Medicaid recipients, known as Qualified Medicare Beneficiaries (QMBs) and Specified Low-Income Medicare Beneficiaries (SLMBs), were created. This study uses the Survey of Income and Program Participation to explore three issues relating to the expansions. First, how much did the QMB expansions increase Medicaid eligibility? Second, how did increases in Medicaid eligibility affect supplemental insurance coverage? Finally, does increased Medicaid coverage translate into increased health care utilization?

There are five principal findings. First, actual Medicaid eligibility increased dramatically, from 8 percent in 1987 to 12.5 percent in 1995. Second, the expansions for the elderly resulted in dramatically higher Medicaid take-up rates than similar expansions for children. For every 100 elderly who became eligible, 49 took it up. Nearly 30 out of 100 elderly dropped private coverage, however, resulting in crowd out of 60 percent. Third, crowd out was concentrated among the youngest of senior citizens. Fourth, crowd out came from individuals dropping privately purchased health insurance rather than dropping employer-provided retiree health insurance. Finally, Medicaid coverage increased the number of hospitalizations, though the findings on health care utilization are generally inconclusive.

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Working Paper: Public Policy and Health Care Choices of the Elderly: Evidence from the Medicare Buy-In Program (1997)
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