RISE looks at the latest news from the Department of Health and Human Services as well as studies that impact Medicare.

Could lowering age of Medicare eligibility to 60 reduce health care costs? Reports offer conflicting views

A new study from the Kaiser Family Foundation shows that lowering the age of Medicare eligibility to 60 could improve the affordability of coverage for people who are already insured and expand coverage to more than a million of the nation’s 30 million uninsured.

The policy could provide a path to Medicare coverage for up to 11.7 million people with employer-based insurance and 2.4 million with private, non-group coverage who are ages 60 to 64, although it is unclear how many would take up such coverage. Another 1.6 million people age 60-64 are uninsured and would be eligible for Medicare coverage under such a policy.

Lowering the age of Medicare eligibility could shift the cost of coverage largely from employers to the federal government and lower the cost of coverage for newly eligible people while increasing federal spending, according to the KFF report.

President Biden proposed lowering the age of Medicare eligibility to 60 during the presidential campaign and reiterated his support recently. Proposals to lower the age of Medicare, either to 60 or a younger age, may be considered by Congress.

But a new Avalere analysis finds that while lowering the Medicare eligibility age may expand access to Medicare coverage for an additional 24.5 million individuals, Medicare premiums may be less affordable in some cases than subsidized exchange coverage.

Avalere said that the way the Medicare program is currently designed could lead to some low-income beneficiaries—particularly those who switch from subsidized exchange coverage—spending more on premiums in Medicare than they currently spend. For lower-income individuals (e.g., those at 138 percent of the federal poverty level), current exchange subsidies are consistently more generous than the subsidies available to Medicare beneficiaries, the analysis found. But those with higher incomes may see significant premium savings.

“Under an expansion, the intricacies of the Medicare program will create winners and losers,” said Massey Whorley, associate principal at Avalere. “Policymakers need to consider all the potential impacts to ensure that patients benefit from better coverage and lower premiums under a Medicare expansion, regardless of their income.”

HHS to give states $3B in grants to address addiction, mental health

The Department of Health and Human Services announced the Substance Abuse and Mental Health Services Administration (SAMHSA) will distribute $3 billion in American Rescue Plan funding for mental health and substance use block grant programs. The funding will allow states to provide comprehensive community mental health services and address needs and gaps in existing treatment services for those with severe mental health conditions. It also will help states plan, implement, and evaluate activities to prevent, treat, and help more people recover from substance use disorder.

The news comes on the heels of a Centers for Medicare & Medicaid Services (CMS) report last week that found vulnerable populations have not accessed mental health services even as mental health conditions worsened during the pandemic. From March through October 2020, beneficiaries have forgone millions of primary, preventive, and mental health care visits due to COVID-19 compared to the same time period in 2019.

"Behavioral health is a priority for the Department of Health and Human Services. The COVID-19 pandemic has made clear the need to invest resources in our nation's mental health and address the inequities that still exist around behavioral health care. That's why we are making this historic investment in mental health and substance use services," said HHS Secretary Xavier Becerra in the HHS announcement.

The department will also establish a new Behavioral Health Coordinating Council to facilitate collaborative, innovative, transparent, equitable, and action-oriented approaches to addressing the HHS' behavioral health agenda.

Report: Most Medicare covered older adults are satisfied with their coverage, costs

A Kaiser Family Foundation analysis released on Monday looks at the current experiences of Medicare beneficiaries ages 65 and older to determine their satisfaction and examines whether privately-insured adults ages 50 to 64 report access or cost problems at higher or lower rates than Medicare beneficiaries 65 and older. The study draws its conclusions based on data from the 2018 Medicare Current Beneficiary Survey and the 2019 National Health Interview Survey.

Key findings from the study reveal:

  • Ninety-four percent of adults 65 and older with Medicare coverage report being very satisfied or satisfied with the quality of their medical care and the availability of specialists
  • Most privately-insured adults ages 50 to 64 and Medicare-covered adults ages 65 and older report having a usual source of care in a setting other than an emergency department (96 percent for both insurance groups)
  • Sixteen percent of privately-insured adults ages 50 to 64 compared to 11 percent of Medicare-covered adults ages 65 and older report having cost-related problems (defined as delaying or forgoing medical care due to costs or having problems paying medical bills)
  • The affordability gap is wider among adults in relatively poor health: one-third of privately-insured adults ages 50 to 64 report cost-related problems compared to one-fifth of Medicare-covered adults ages 65 and older