Medicare Expansion: President Clinton's Proposals to Allow Coverage Before Age 65 Page: 4 of 6
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age 65, estimated to be about $300 in 1999 (though subject to geographic variation); and
a deferred premium for ages 65 through 84, estimated to be about $10 a month in 1999
for each year of early participation (not subject to geographic variation).' Thus, a person
who bought-in for three years would pay a deferred premium of about $30 a month in
addition to what they pay for their Part B premium. The base premium is not intended to
cover the full cost of people who buy in; in effect, Medicare would be loaning early
enrollees the difference and then obtaining repayment with interest from the deferred
premium during the 20 years after they turn 65. The base premium could be adjusted
yearly to reflect cost changes, but the deferred premium, made known at the time of
enrollment, would be changed only for subsequent enrollees. No Medicaid assistance
would be available for premiums or cost-sharing. People may enroll within two months
of either turning 62 or losing federal or employer-sponsored health insurance; they would
not have to elect or exhaust COBRA coverage. If they disenroll, they could not re-enroll
unless they obtained and subsequently lost federal or employer-sponsored insurance
including eligibility for COBRA coverage.
The second group allowed to buy in includes persons ages 55 through 61 who lose
their job because their firm closed, downsized, or moved or because their position was
eliminated. They must meet requirements for receiving unemployment compensation and
must also lose health insurance (after having at least 12 months of creditable coverage)
because of this displacement and not have access to federal or employer-sponsored
insurance including any COBRA coverage. The spouse of an eligible person could also
buy in. Participants would be charged geographically-adjusted premiums (one for people
ages 55 through 59 and another for those ages 60 and 61) that would be approximately
$400 a month in 1999. They would not pay a deferred premium after turning 65 since the
$400 monthly base premium is intended to cover their full cost. People who disenroll or
obtain federal or employer-sponsored insurance could re-enroll only if they were displaced
once again. If displaced workers had no federal or employer-sponsored health insurance
after turning 62, they could obtain Medicare coverage under the terms described above.
Policy Issues. Coverage. The President's proposals are a response to the concern
that many people ages 55 through 64 do not have access to affordable health insurance.
They are targeted to several groups including individuals with pre-existing conditions who
are unable to get coverage through other sources, persons who are sick, individuals with
Medicare-eligible spouses who are not eligible themselves because they are not yet 65, and
persons who are displaced from their jobs and lose accompanying health insurance.Some critics of the President's plan suggest that it addresses these problems in a
piecemeal fashion and only covers a portion of the target population. (A preliminary
estimate by CBO is that about 410,000 persons out of the 3 million uninsured ages 55
through 64 would elect coverage under H.R. 3470/S. 1789 (including the expanded
COBRA option discussed below)). There is also concern that the availability of Medicare
at age 62 might encourage some people to retire earlier or to enroll in public rather than
private insurance. Some suggest that employers might be further encouraged to drop all
or a portion of their retiree health coverage. Others urge that the private sector should be
encouraged (perhaps with use of tax incentives) to address the health insurance needs of'Premium estimates in this report were made by the Congressional Budget Office (CBO).
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Lyke, Bob; Fuchs, Beth C.; O'Sullivan, Jennifer & Smith, Madeleine T. Medicare Expansion: President Clinton's Proposals to Allow Coverage Before Age 65, report, March 31, 1998; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metacrs502/m1/4/?q=%22aged%22: accessed May 23, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.