Estimated 13 Million Adults Could Be Eligible for Clinton's Expanded Medicare Proposal

An analysis by Avalere Health of Hillary Clinton’s proposal to allow Americans age 50 and over to Medicare estimates that 13 million adults who are uninsured or have individual coverage through the private market could be eligible for such a program.

The Clinton campaign has not, however, released specific details about the “Medicare for More” proposal. The pre-Medicare age group that can be potentially affected by Medicare for More has been a demographic most attracted to the exchange market, Avalere noted. In 2016, nearly half of exchange enrollees are 45 or older, with 26% of them age 55 or older.

According to Avalere’s analysis, although traditional fee-for-service Medicare tends to offer broader access to physicians than many other plans, costs to beneficiaries may be higher than over coverage options, including plans purchased through both federal and state insurance marketplaces.

The Avalere analysis estimates that there are 63 million Americans between the ages of 50 and 64 years old who can potentially be affected by Clinton’s proposal. Sixty-one percent of these have insurance coverage through employers and would be unlikely to be affected by the proposal. But 7 million (11%) of those age 50 and over remain uninsured and could benefit from this newly proposed program. An additional 5.9 million (9%) are currently insured in the individual market and could decide to enroll in Medicare instead of the private market.

Although Medicare is very popular, Avalere’s experts say it is not immediately evident that Medicare coverage would be a better option for everyone over age 50. Compared with products sold through insurance exchanges, traditional fee-for-service Medicare tends to offer a broader provider network and lower deductibles compared with unsubsidized exchange plans. But consumers enrolling in the program may have higher costs and more benefit limits than in exchange plans.

Maximum out-of-pocket (OOP) costs that patients can incur is one big area of differentiation between Medicare and private plans. Employees and exchange plans have caps on OOP costs but Medicare does not. Thus beneficiaries with high healthcare costs can pay more OOP with Medicare. Coinsurance for physician visits could also be a big cost difference. Medicare charges 20% coinsurance costs for all Part B services, which covers a lot of services: physician visits, lab tests, physician administered drugs, and durable medical equipment. Medigap policies to reduce these costs are expensive if purchased. Finally, drug benefits could also be less generous under Medicare.

“Despite exchanges attracting millions of Americans 50 and over, millions more remain uninsured. While individuals are likely to stick with employer coverage if they currently have it, this proposal may give consumers another option to become insured,” said Elizabeth Carpenter, senior vice president at Avalere.