Saturday, March 15, 2014

Medicare Part C Added

On March 15, 2014 we updated to show details of the federal Medicare Part C program, Medicare Advantage.

Historical Table 3.2, published each year in the Historical Tables section of the Budget of the United States, is the primary source we use for showing federal outlays down to the "subfunction" level.  Table 3.2 includes about 80 line items.  But Medicare appears as a single line item, subfunction 571.

Previously, we have broken out outlays for Part A Hospital Insurance, Part B Supplementary Medical Insurance, and Part D SMI Drug programs from single subfunctions.   We have constructed these outlays from detailed items published in the Public Budget Database.

Details of Part C Medicare are not provided in the Public Budget Database, but they are shown in the annual Medicare Trustees Report, and we have extracted data from the reports to construct a data series for Part C Medicare Advantage.  You can inspect the extracted data from Medicare Trustees Reports here.

Strictly speaking, Part C Medicare Advantage started in 2006.  But the Balanced Budget Act of 1997 created Medicare+Choice, really a precursor of Medicare Advantage, and the Medicare Trustees Report tracks the cost of Medicare+Choice's payments to private health plans and then Medicare Advantage's payments to private health plans.  Thus we have extended Part C back to 1998.

In the Public Budget Database Part C Medicare Advantage outlays are included as part of Part A and Part B outlays.  They are recorded in the Medicare Trustees Report as “Medicare Payments to Private Health Plans” from Part A and Part B trust funds.  In creating the new Part C line items we have reduced the HI (Part A) Benefits and SMI (Part B) Benefits line items so that the overall totals remain the same.

Also, Medicare Part A and Part B subtract "Premiums and Collections" from their published Outlays.  For Part A this is a nominal amount.  But we have prorated the Part B Premiums and Collections between Part B and Part C, and we have provided a line item for Part C "Prorated Premiums and Collections."  The proration for Part B Premiums and Collections looks like this:
SMI (Part C) Prorated Premiums and Collections = SMI (Part B) Premiums and Collections * (SMI (Part C) Private Health Plan Bid + SMI (Part C) Private Health Plan Rebate) / ( SMI (Part C) Private Health Plan Bid + SMI (Part C) Private Health Plan Rebate+ SMI (Part B) Benefits)
The SMI (Part B) Premiums and Collections is reduced by the amount of SMI (Part C) Prorated Premiums and Collections. has now surfaced the Part A, Part B. Part C, and Part D outlays up to the subfunction level by extending our unofficial subfunctions for the Medicare program as follows:

572HI (Part A) Benefits
573HI (Part A) Administration
574HI (Part A) Premiums and Collections
575SMI (Part B) Benefits
576SMI (Part B) Administration
577SMI (Part B) Prorated Premiums and
581SMI Drug (Part D) Benefits
582SMI Drug (Part D) Administration
583SMI Drug(Part D) Premiums and Collections
585HI (Part C) Private Health Plan Bid
586HI (Part C) Private Health Plan Rebate
587SMI (Part C) Private Health Plan Bid
588SMI (Part C) Private Health Plan Rebate
589SMI (Part C) Prorated Premiums and

You can find the new detailed Medicare numbers on the Medicare Spending Details page here and the Medicare Spending by Year page here.  You can also look at the Entitlements History page here.

Reminder: The fifteen "subfunctions" 572 through 589 are not official US government subfunctions.

See the blog entry that announced Medicare Part A, Part B, Part D details here.

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