Medicare eligibility expansion could also affect about 2.6 million people ages 60 through 64 who would qualify for early access to Medicare in 2031 because they were disabled or had severe kidney disease.
The analysts note that the expansion proposal they reviewed would provide Medicare Part A hospitalization coverage for all, for free, at age 60, but that consumers would still have to pay for Medicare Part B physician and outpatient services coverage.
Some people who ended up with Medicare Part A coverage might decline to pay for Medicare Part B coverage, the analysts warn.
“Because Part A alone does not provide comprehensive medical coverage, CBO would categorize anyone enrolled in only Part A without any other form of coverage (such as Medicare Part B, employment-based coverage, or Medicaid) as uninsured,” the analysts write.
The analysts predict that, in the real world, Medicare eligibility expansion would increase the number of people with Medicare coverage as their primary source of health insurance by 7.3 million.
The analysts estimate that 4.8 million extra people would combine Medicare Part A with other primary coverage; 900,000 people would use Medicare Part A and Medicare Part B coverage as secondary coverage; and 500,000 people would have only Medicare Part A coverage and be classified as uninsured.
The CBO and JCT analysts focus mainly on the net impact of Medicare eligibility expansion on federal budget deficits, and the overall federal debt.
But they also provide separate figures for outlays and receipts.
Medicare eligibility expansion could increase total Medicare outlays by $449 billion over the six-year period analyzed, but enrollees and state Medicaid programs could increase the amounts they send to the federal government by $74 billion, the analysts predict.
Other expansion effects could decrease federal spending and increase revenue and narrow the six-year impact on the budget debt to $155 billion, the analysts report.
Sources of Uncertainty
The analysts emphasize that it’s hard to know how many people ages 60 through 64 would sign up for Medicare Part B coverage or use Medicare Part A coverage as a primary payer.
“It is unclear how newly eligible people would weigh several factors when deciding whether to enroll in Medicare, including ease of enrollment, premiums, cost sharing, late-enrollment penalties, and perceived coverage quality,” the analysts say. “Additionally, the health care utilization of new Medicare enrollees is uncertain. Those new enrollees might be more or less healthy than CBO anticipates, resulting in lower or higher health care utilization.”
The Role of Live Humans
The analysis suggests that Medicare eligibility expansion could increase the Medicare program’s need to use live-human agents, enrollers or navigators, or automated systems, to educate people ages 60 through 64 about any new coverage options created.