An Updated Measure of Poverty (Re)Drawing the Line (2023) / Chapter Skim
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Appendix 3B: Examples of PPM versus SPM Treatment of Health Insurance and Medical Care
Appendix 3B: Examples of PPM versus SPM Treatment of Health Insurance and Medical Care
Pages 56-58
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From page 56... ...
Individuals with unsubsidized private coverage or no coverage at all are not receiving a health insurance transfer, so nothing is added to their resources. Finally, actual nonpremium out-of-pocket spending on medical care (MOOP)
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From page 57... ...
Thus, MAPD plans will have identifiable maximum out-of-pocket limits for medical care and prescription drug spending.) Example 1: Single individual, age less than 65 and not Medicare eligible Assumptions • Benchmark premium is $5,000 • Out-of-pocket spending on premiums varies with coverage type: • Employer-sponsored coverage: $1,200 • Medicaid: $60 • Marketplace coverage with a tax credit: $1,000; value of tax credit is $4,000 • Marketplace coverage without a tax credit: $5,000 • Regardless of coverage type, non-premium MOOP spending is $500 Resources Needs Panel 1A Supplemental Poverty Measure ($)
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From page 58... ...
($) 1. Threshold adjustment: Add imputed Medicare premium to needs +10,000 2. Resource adjustments for health insurance premiums: Add average total value of Medicare spending to resources +10,000 Subtract actual Part B out-of-pocket premium −1,800 3. Resource adjustment for out-of-pocket medical care: Subtract reported out-of-pocket medical care or −1,000 prescription drug spending (currently uncapped)
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