Medicare version 2.0 Version History

FILING UNITS AND ELIGIBILITY TESTS

The filing unit in the Medicare program is an individual. Individuals qualify for Medicare if they are covered by the Social Security system and either reach old age (65 or older), or develop a disability severe enough to prevent gainful employment. Categorical eligibility is equivalent to full eligibility; no additional asset or income test is applied.

In TRIM3, all persons 65 and over who report receipt of Social Security benefits in their CPS interviews are simulated to be eligible for Medicare. Persons 65 and over who do not report Social Security are considered eligible for Medicare if they were not simulated as participating in SSI or AFDC, on the assumption that they simply failed to report their Social Security benefits. Aged participants in SSI or AFDC who do not report Social Security are not awarded Medicare eligibility, since their low income makes it more likely that they are part of the small population not covered by Social Security.

Adults under age 65 who report receiving Social Security benefits, and who did not work for all or part of the year due to disability (indicated by the variables LastReasonNotWorking and LastRemainingActivity), are considered to be eligible for Medicare as disabled persons

Children (i.e. persons under 15) are never considered for Medicare eligibility.

BENEFIT DETERMINATION

The benefit amounts assigned by the Medicare module are insurance values. The model uses the average annual market values per beneficiary for in each state for each of two types of Medicare eligibility, old age and disability. The program rules MarketValOfMedicareForDisabled and MarketValOfMedicareForElderly give these values. A Medicare value is given to all eligibles.

PARTICIPATION (ENROLLMENT) DECISION

All aged persons simulated as eligible for Medicare are also simulated to enroll. Among disabled persons, only those eligible and reporting Medicare are simulated to enroll.

REPORTER STATUS

For various purposes, the Medicare simulation needs to know whether a person should be considered a "reporter" – i.e. did they report coverage under Medicare on the CPS. In TRIM3’s simulation of Medicare, a reporter is anybody who reports coverage (i.e. the variable HealthMedicareCoverage = 1), but whose coverage was not allocated by Census (i.e. the variable AllocFlagMedicareCoverage is not equal to 1). The result of this determination can be stored for each person by setting the "output mode" to "output" in the form IsMedicareReporter.