America Living With AIDS

AMERICA Living

would not be required to change their
source of care, as they would if they
were covered under Medicaid and
their physicians or hospitals did not
participate in Medicaid. This option
might take some of the burden of providing care away from the teaching
and public hospitals and away also
from those physicians who accept
Medicaid patients.
This option results in a net savings
to Medicaid because costs are shifted
from the Medicaid program to
employers through continuing coverage under employer-sponsored insurance plans. Overall FY 1991 savings to
Medicaid would be $4 million for
both people with HIV infection and
people with AIDS. Of this, $28 million is saved for those with AIDS,
whom otherwise Medicaid would have
had to pay for, while the net cost is $24
million for people with HIV infection.
SSDI beneficiaries who are disabled
and have HIV disease or another serious chronic health condition should
have the option of purchasing Medicare during the current two-year waiting period. Medicaid would be
required to purchase Medicare coverage for low-income SSDI beneficiaries.
This option would allow an estimated 10,500 SSDI beneficiaries with
AIDS to purchase Medicare coverage.
An estimated 4,900 would have their

Medicare coverage purchased and
supplemented by Medicaid; 5,600
would purchase Medicare on their
own. Once eligible for SSDI, an individual would immediately be allowed
to purchase Medicare coverage without having to wait out the 24-month
waiting period. The annual cost to the
beneficiary would be $3,559-the full
actuarial cost for Part A (Hospital
Insurance) and Part B (Supplemental
Medical Insurance) premiums. In
addition, beneficiaries would be liable
for Medicare cost sharing and noncovered services such as prescription
drugs. The cost to beneficiaries is
therefore estimated to be $9,600 annually. Individuals with incomes above
the federal poverty level would be
expected to make these payments.
Owing to the potentially large out-ofpocket cost to the individual, it is estimated that only 35 percent of the
SSDI beneficiaries would take advantage of this option.
Private supplemental insurance
policies (called Medi-gap policies)
should also be opened up to people
with HIV disease who can afford to
purchase them. These policies are
often the only way to cover the cost of
prescription drugs and long-term care
for Medicare beneficiaries.
There are significant gaps and cost
sharing in the coverage provided by
Medicare, which would put a heavy
financial burden on many individuals
purchasing Medicare under this
option. Specifically, out-of-pocket
costs for Part A include a deductible of
$628 per episode of illness. Out-ofpocket costs for Part B, the coverage

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