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The 95-105 age group: CBO analyzes an under-analyzed Medicare market

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In 2010, the Medicare program may covered 570,000 people ages 95 and older, including as many as 8,600 people ages 105 and older.

Xiaotong Niu, an analyst at the Congressional Budget Office (CBO), and two other analysts have published that data on extremely old Medicare beneficiaries in a new paper distributed by the CBO.

The analysts prepared the paper to look at why Medicare costs have been going up so much, and why costs seem to be going up more for older enrollees.

See also: 4 things to consider for longevity planning

Medicare is not supposed to pay for true long-term care (LTC) services, but it does pay for home health care for people with acute health care needs. The program also pays for skilled facility care — nursing home care — for patients who are recovering from acute health care problems, and it pays for hospice care for patients who are believed to be near death.

When a patient is getting hospice care, Medicare will pay for nursing care, pain relief drugs, occupational therapy, social work services, dietary counseling, grief counseling, homemaker services and short inpatient stays, according to a Medicare fact sheet.

See also: Preparing is caring: Long-term care does not have to be a crisis

In one table, the CBO analysts compare traditional Medicare spending patterns for enrollees in four different age groups in 1999 with spending patterns for enrollees in those same age groups in 2005 and 2012. The big change was in the hospice services column: The cost of hospice services increased sharply, and the number of Medicare enrollees getting hospice services skyrocketed.

For Medicare enrollees ages 85 to 94, the percentage of Medicare spending going to hospice care jumped to 7.9 percent in 2012, from 2.3 percent in 1999. For enrollees ages 95 to 105, the percentage going to hospice care soared to about 19 percent, from 4.2 percent.

See also: With Boomers Coming, Hospice Industry Diversifies

On the way to implying, indirectly, that the oldest enrollees’ Medicare bills may be climbing partly because hospice care has become a substitute for LTC services, the CBO analysts provide a glimpse of the very oldest old demographic group.

The analysts note, for example, that the Census Bureau counted only about 53,000 U.S. residents in 2010. Medicare had about 216,000 centenarians on its enrollee list that year.

Many of the centenarian enrollees may actually be dead, the analysts write.

The analysts tried to adjust for failures to report enrollee deaths by excluding Medicare enrollees who had not paid their Part B premiums or filed any claims.

The percentage of apparent Medicare Part A enrollees who either paid Part B premiums in 2012 or filed claims that year was more than 95 percent for the 96-year-olds, for example, but only about 20 percent for the 110-year-olds. The analysts’ unreported-death adjustment cut the number of estimated centenarian Medicare enrollees to about 96,000, including about 8,600 people ages 105 to 109 and about 16,000 people ages 110 and older.

Even after the unreported-death adjustment, the analysts’ Medicare centenarian enrollee list for 2012 may include some dead people with inattentive estate executors; some cases of fraud; and some people under the age of 105 affected by Medicare recordkeeping problems.

Average inflation-adjusted Medicare spending on enrollees ages 95 to 105 increased 72 percent between 1999 and 2012, to $13,634 in 2009 dollars.

The average for enrollees ages 85 to 94 increased just 50 percent over that period, to $12,588 in 2009 dollars. Spending on enrollees ages 65 to 74 increased 25 percent, to $5,601 in 2009 dollars.

Excluding spending on hospice care and skilled nursing facility care, Medicare spending on enrollees ages 95 and older tends to be lower than spending on younger enrollees, the analysts found.

In 2012, Medicare spending on services other than hospice and nursing facility care for 104-year-olds was about $6,000 in 2009 dollars, which was about the same as the average spending on 70-year-olds.

See also: View: Another reason no one should want ‘death panels’

In a look at how the split between traditional Medicare and Medicare Advantage might affect the results, the analysts show that Medicare enrollees over age 95 are more likely than other enrollees to be in traditional Medicare.

More than 30 percent of the 2012 enrollees in their 70s had Medicare Advantage coverage, but fewer than 25 percent of the 95-year-old enrollees had Medicare Advantage coverage, and fewer than 15 percent of the 105-year-olds had Medicare Advantage coverage. They were substantially less likely to have Medicare Advantage coverage than members of any other age group.

From 1999 to 2012, only about 0 percent to 2 percent of the members of the 95-105 age group who had traditional Medicare in any given year switched to Medicare Advantage the following year.

From 2002 to 2012, members of the 90-105 age group who had Medicare Advantage coverage were about as likely as members of other age groups to switch to traditional Medicare coverage.