Skip to main content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Estimated Savings of $5,000 to Each Medicare Beneficiary from Enactment Through 2022 Under the Affordable Care Act

Publication Date

This report provides estimates of Medicare Parts A, B, and D savings from the Affordable Care Act to seniors and people living with disabilities enrolled in traditional Medicare. The Affordable Care Act will favorably affect beneficiary expenditures in four ways: lowering part B premiums growth, lowering beneficiary copayments and coinsurance growth under Part A and B, closing the Medicare prescription drug coverage gap, and providing many preventive services to seniors at no additional cost. The study estimated the savings to beneficiaries from these effects for the 2010-2022 period.

"

Summary

The Affordable Care Act, enacted in 2010, makes many changes to strengthen Medicare and provide better benefits to seniors, while slowing cost growth. As a result, average Medicare beneficiary savings in traditional Medicare will be approximately $5,000 over the 2010 to 2022 period (see Table 1). Beneficiaries who have high prescription drug spending will save much more – more than $18,000 over the same period.

This issue brief provides estimates of savings to seniors and people living with disabilities enrolled in traditional Medicare from the provisions in the Affordable Care Act. The Affordable Care Act favorably affects beneficiary expenditures in four ways. First, premiums for Part B physician and certain other services are expected to increase at a slower rate than would have occurred without the Affordable Care Act, resulting in lower Part B premiums over time. Second, beneficiary copayments and coinsurance under Parts A and B will increase more slowly because the Affordable Care Act slows the rate of growth in payments to hospitals and other providers. Third, closing the Medicare prescription drug coverage gap, often called the “donut hole,” will lower costs for beneficiaries who otherwise would have been required to spend thousands of dollars out of their own pockets for their prescription drugs. Finally, the Affordable Care Act provides many preventive services to people with Medicare at no additional cost.

The Affordable Care Act will lower Medicare spending compared to the baseline prior to the law’s passage through reductions in extra subsidies paid to Medicare Advantage plans; reductions in the rate of growth in provider payments; efforts to make the Medicare program more efficient, coordinated, and quality-oriented; and reductions in waste, fraud and abuse. These provisions will lead to corresponding savings for beneficiaries through lower copayments and premiums. An expected slower rate of growth in Medicare spending leads to a slower rate of growth in beneficiary out-of-pocket payments, and a slower rate of growth in Part B premiums. In addition, the closing of the donut hole will result in large savings for beneficiaries with high levels of prescription drug spending.

Average savings per Medicare beneficiary in traditional Medicare are estimated to be $160 in 2012, increasing to $812 in 2022 (see Table 1). For a beneficiary with spending in the donut hole, total estimated annual savings increase from $735 in 2012 to $2,599 in 2022.

Table1. Annual Savings per Beneficiary in Traditional Medicare Under The Affordable Care Act

 ActBeneficiary Not Reaching theDonut Hole ($)Beneficiary Reaching the Donut Hole ($)All Fee-For-Service Beneficiaries ($) 
2010-624420
20112763190
201292735209
2014168996251
20152121.152303
20162611.327362
20173101.555426
20183541.799488
20194052.075559
20204622.196623
20215392.386710
20226292.599812
 
Total 2010-223.58718.5535.013
Total 2013-223.47416.9434.743

Notes:

  1. Savings include parts A, B, and D effects. Part A & B, and D premium savings for 2010-19 estimated by OACT.
  2. Parts A and B estimates for 2010-19 are provided by OACT, John Shatto's memo on October 5, 2010.
  3. Estimates for 2020-22 are computed by ASPE in consultation with OACT.
  4. Savings for beneficiaries in the donut hole estimated by ASPE, using Medicare Part D data in 2010 generated by Acumen for ASPE (Non-LIS FFS Beneficiaries with at least 1 Month in D in 2010) and the discounts to beneficiaries in 2011 are benchmarked to CMS analysis of 2011 PDE claims data.

Changes in premiums and cost-sharing will also occur in the Medicare Advantage (MA) program. The Affordable Care Act strengthens this program by gradually eliminating excessive payments to health plans, rewarding quality, and improving protections for beneficiaries against overly high cost sharing. The most recently available data on Medicare Advantage plans suggest that enrollment for 2013 in the MA program is projected to increase by 11 percent from 2012 and premiums will remain steady.1


1 “Medicare Advantage remains strong,” Press Release, U.S. Department of Health and Human Services, September 19, 2012, available at http://www.hhs.gov/news/press/2012pres/09/20120919a.html.
To find recent press releases on MA and Part D contract and enrollment, visit: http://www.cms.gov/apps/media/press_releases.asp

Methods

This memo was prepared by analysts in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in consultation with the Office of the Actuary (OACT) of the Centers for Medicare & Medicaid Services (CMS). The net savings for traditional Medicare beneficiaries from reduced Part B premiums, reduced Parts A and B coinsurance and copayments, and from increased Part D premiums were estimated by OACT in 2010 (note: they have not been updated for actual experience from 2010 through 2012).2 Actual savings from reduced Parts A and B coinsurance will vary across beneficiaries. Beneficiaries with multiple chronic conditions, those using a higher-than-average volume of services, as well as those who make greater use of preventive services, will enjoy a greater-than-average amount of savings. The estimated effects for beneficiaries not reaching the donut hole are shown in Table 2.

Table2. Components of Affordable Care Act Annual Savingsper Fee-For-Service Beneficiary Not Reaching the Donut Hole

 HoleEffects of reduced increasedTotalpart B premium (Annual $)Effects of reduced A & B coinsurance (Annual $)Effects of increased part D premium (Annual $)Total Effect (Annual $) 
20100-60-6
20111914-627
20125341-292
201372620134
20149079-1168
2015113101-2212
2016139124-2261
2017169148-7310
2018192175-13354
2019218207-20405
2020248245-31462
2021281291-33539
2022319346-35629

Notes:

  1. Estimates for 2010-19 are provided by OACT, John Shatto's memo on October 5, 201
  2. Estimates for 2020-22 are computed by ASPE in consultation with OACT.

The Affordable Care Act requires drug manufacturers to provide a discount for covered brand name Part D drugs sold to beneficiaries in the donut hole (50 percent starting in 2011) and provides subsidies for covered brand name Part D drugs to those beneficiaries rising from 2.5 percent in 2013 to 25 percent in 2020. Finally, the Affordable Care Act provides subsidies for generic drugs purchased in the donut hole beginning at 7 percent in 2011 and rising to 75 percent in 2020. Together, these changes mean that a beneficiary will pay the standard 25 percent coinsurance in a standard plan in 2020 for generic and brand drugs, and the donut hole will be closed.

Since the Affordable Care Act was enacted, 5.4 million people with Medicare have saved over $4.1 billion on prescription drugs in the donut hole, and an estimated 37 million people with Medicare have received a preventive benefit free of charge.3

The Affordable Care Act also lowers the rate of growth of the out-of-pocket threshold for drug spending by beneficiaries in the donut hole from 2014 to 2019. We estimate savings to beneficiaries from this change using a combination of information from OACT and results from the analysis described above.4

The estimates are presented in Table 3 below. For beneficiaries with spending in the donut hole, total estimated Parts A, B, and D savings increase from $735 in 2012 to $2,599 in 2022.

Table3. Components of Affordable Care Act Annual Savingsper Fee-For-Service Beneficiary Reaching the Donut Hole ($)

 Effects of reduced A & B coinsurance and B premium /1Effect of increased D premium /1Filling the donut hole /2 for a beneficiary whose spending reaches the holeReducing the growth in part D OOP threshold for a bene in the gap /1Total Effect (Annual $)
2010-602500244
201133-66040631
201294-26430735
201313407230857
2014169-178048996
2015214-2879621.152
2016263-29541121.327
2017317-71.1141311.555
2018367-131.2931531.799
2019425-201.4921782.075
2020493-311.73402.196
2021572-331.84702.386
2022665-351.96902.599

Notes:

  1. Estimates for 2010-19 are provided by OACT, John Shatto's memo on October 5, 2010; and estimates for 2020-22 are computed by ASPE in consultation with OACT.
  2. Estimates by ASPE based on Medicare Part D data in 2010 generated by Acumen for ASPE (Non-LIS Beneficiaries with at least 1 Month in D in 2010) and the discounts to beneficiaries in 2011 are benchmarked to CMS analysis of 2011 PDE data.

Part D estimates incorporate 3 effects: (1) savings due to filling the doughnut hole, (2) savings due to reducingthe growth rate of the catastrophic threshold during 2014-19, and (3) an offset from increased part D premium.


2 Memo by John Shatto, Director of Medicare & Medicaid Cost Estimates Group, CMS Office of the Actuary, October 5, 2010.

3 “Medicare Advantage remains strong,” Press Release, U.S. Department of Health and Human Services, September 19, 2012, available at http://www.hhs.gov/news/press/2012pres/09/20120919a.html; or “Medicare Prescription Drug Premiums to Remain Steady for Third Straight Year,” Press Release, Centers for Medicare & Medicaid Services, August 6, 2012, available at http://www.cms.gov/apps/media/press_releases.asp.
4 “Estimated Financial Effects of the ‘Patient Protection and Affordable Care Act,’ as Amended,” Memo from Richard Foster, Office of the Actuary, Centers for Medicare & Medicaid Services, April 22, 2010, Table 3, Section 1101. In this memo, OACT estimated that the cost to Medicare from the slower growth in the out of pocket threshold was approximately 11% of the cost to Medicare from closing the donut hole. We apply this 11% estimate to our estimate of the cost to Medicare from closing the donut hole to estimate the savings to beneficiaries from the slower growth in the out-of-pocket threshold from 2014 to 2019.
Files
Product Type
Report
Populations
Medicare Beneficiaries
Location- & Geography-Based Data
National Data
Program
Medicare