Tricia Neuman

Health Coverage and Expenses: Impact on Older Women's Economic Well-Being

The health issues women face over the course of their lives, as well as policies that shape Medicare, Medicaid, and other supplemental coverage can affect retired womens economic well‐being. This study uses a nationally representative sample of Medicare beneficiaries aged 65 and older in 2002 to explore gender‐based differences in health and long‐term care use, spending patterns, and the financial burden of health and long‐term care out‐of‐pocket health expenses. Womens health care expenses were higher than mens; older women paid for a greater share of their total spending out of pocket and they faced a greater financial burden by shouldering these out‐of‐pocket costs with less income at their disposal. Low‐income women, those with Medigap or no supplemental coverage, and white women, who are less likely to qualify for Medicaid which covers long term care, faced the greatest financial burdens associated with health and long‐term care costs. The implications of these findings for women in the context of the current health policy landscape are discussed. Controlling health spending and developing options to finance long‐term care are key elements of the policy solutions that will need to be developed to preserve and support economic security for millions of retired women in the United States.

The Private Health Insurance Choices of Medicare Beneficiaries How Much Does Price Matter

This article presents, critiques, and analyzes the influence of prices on insurance choices made by Medicare beneficiaries in the Medicare Advantage, Part D, and Medigap markets. We define price as health insurance premiums for the Medicare Advantage and Medigap markets, and total out-of-pocket costs (including premiums and cost sharing) for the Part D market. In Medicare Advantage and Part D, prices only partly explain insurance choices. Enrollment decisions also may be influenced by other factors such as the perceived quality of the higher-premium plans, better provider networks, lower cost-sharing for services, more generous benefits, and a preference for certain brand-name products. In contrast, the one study available on the Medigap market concludes that price appears to be associated with plan selection. This may be because Medigap benefits are fully standardized, making it easier for beneficiaries to compare alternative policies. The article concludes by discussing policy options available to Medicare.