222250 Cost of caring for 55-64 year olds in Palm Beach County, FL: A model for Medicare expansion

Monday, November 8, 2010 : 9:10 AM - 9:30 AM

Ronald Wiewora, MD, MPH , Health Care District of Palm Beach County, Palm Springs, FL
Thomas Cleare, MBA , Health Care District of Palm Beach County, West Palm Beach, FL
        
Problem: One of the proposals for Health Reform extends Medicare coverage to people aged 55-64. Vita Health, a flex plan administered by Healthy Palm Beaches, Inc. provides coverage to this age group, similar to the benefits available to older people under Medicare. Utilization data from this program could be used to estimate the cost of Medicare expansion to this age group.

Methods: Claims experience was gathered for Vita Health members between the ages of 55 and 64. A per member per month cost was calculated. This cost was extrapolated to the population of Palm Beach County and the population of the US to provide the cost estimates for expanded coverage. Utilization was also reviewed.

Results: Average per member per month cost of coverage for Vita Health was $216.39. To provide coverage to all residents of Palm Beach County would have a total cost of approximately $280 million. To provide coverage to this age group in the entire US could have a price tag of up to $63 billion. Most frequent conditions treated were diabetes, hypertension and hyperlipidemia.

Conclusions: Extending health coverage to people aged 55-64 would have a significant cost. The amount of this coverage that would be paid by the consumer would depend on the willingness of taxpayers to subsidize this care.

Learning Areas:
Administration, management, leadership
Public health or related public policy

Learning Objectives:
Compare services that are available under flexible coverage plans to Medicare services Discuss how costs are estimated for health coverage in a a population Describe what the financial impact would be under the model utilized

Keywords: Health Reform, Health Care Managed Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Chief Medical Officer for a managed care plan that provides services to this age group.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3033.0: Health Care Reform I