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Life Health > Health Insurance

Medicare trustees look ahead to the year 2090

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You may think you do a good of long-range planning for your practice, but the forecasters who work for the Medicare trustees probably have you beat.

This year, they are doing their best to create long-range health care cost projections and other projections for 2090. The projections incorporate assumptions about workers who may not even be born until about 2076.

The trustees are predicting that the main Medicare Part A hospitalization trust fund may run out of cash in 2028. At that point, Medicare might bring in only enough cash from payroll taxes to pay 87 percent of its 2028 obligations.

Related: Medicare fund to run short in 2028; IPAB still projected in 2017

But, on the other hand, a lot can happen between now and 2028.

Just 17 years ago, in 1999, one of the print publications behind, National Underwriter Life & Health, reported that the Medicare Part A fund was on track to go broke in 2015.

Policymakers stepped in and kept that from happening.

One obvious conclusion to draw is that predicting what will really happen to the Medicare hospitalization insurance program, or any other human program, in 2090 is not possible.

Seventy-four years ago, for example, the United States had just started fighting the Second World War. The United States did not have commercial use of electronic computers, microwave ovens, penicillin or microchips. People had no idea that interstate highways would crowd out street cars, or that urban planners worried about pollution and traffic would try to bring back street cars. Major sources of personal insurance lines health risk included polio and tuberculosis.

In connection with “Star Trek,” writers have looked ahead and decided that Earth will send its first faster-than-light probe out of the Solar System in 2067, which is 23 years before the end data for the long-range projections in the new Medicare trustees’ report. The writers have decided Earth will establish its first permanent Moon colony in 2090.

A great deal could change between now and 2090.

But, on the other hand, if you work downtown in a big U.S. city, chances are you benefit from use of a street grid created by urban planners 100 or more years ago. You may have gray-haired adult clients who are only now cashing in “baby life insurance policies” friends or relatives gave them when they were born 50 or more years ago. 

For life and health insurers, planning what might happen to disability insurance or long-term care insurance insureds 20, 30 or 40 years in the future is part of everyday life.

Thinking about what the United States officially might look like in 2090 could help you think about that kind of medium-range planning in a different way.

For five glimpses of how the Medicare trustees’ forecasters see the United States operating in 2090, read on:

Percentage graphic

(Illustration: iStock)

1. U.S. gross domestic product could amount to about $464 trillion in 2090.

GDP is to a country what total income is to a human being. Economists use “GDP” as a synonym for “national income.”

The 2090 GDP figure is in a supplemental table, “Ratio of HI Taxable Payroll to GDP.”

That’s up from about $18.7 trillion this year, and up from $815 billion in 1966, the earliest year shown in the table.

Taxable payroll could amount to 44 percent of GDP in 2090. That would be down from 44.8 percent this year and up from 37 percent in 1966. 

Related: Medicare Hospital Insurance Trust Fund


(Illustration: iStock)

2. The present value of all GDP the United States will generate from this year through 2090 could be $1.2 quadrillion.

That’s the same as $1,200 times a trillion, or $1.2 followed by 15 zeroes.

This figure is on Page 220 of the Medicare trustees’ report PDF file, and on Page 214 according to the page numbers given in the report itself.

The amount of payroll subject to Medicare hospitalization program payroll taxes could amount to $535 trillion over the period.

The amount of payroll subject to Social Security retirement income and disability payroll taxes could amount to $455 trillion.

The present value of what the hospital fund might take in could be about $21 trillion. The present value of the cash flowing into the Social Security fund could be $60 trillion.

The present value of premium revenue at the Medicare Part B outpatient and physician services program, which depends mainly on current revenue to cover the cost of claims, could be $11 trillion.

Related: Boomers’ Retirement Will Profoundly Impact U.S.

Plastic people

(Illustration: Thinkstock)

3. The Medicare Part A hospitalization program could have 120 million enrollees.

That would be up from about 57 million this year, and up from about 20 million in 1970, according to a table on Page 192 of the PDF file, or Page 186 by the trustees’ numbering.

Medicare Part D prescription drug program enrollment could increase to 92 million, from 43 million today, and 31 million in 2006, the program’s first full year of operation.

The private insurers that offer Medicare Part C Medicare Advantage plans might be sad to see that the trustees show enrollment in that program increasing to 31 million in 2040, from 18 million today, but disappearing after 2040.

“The trustees do not explicitly project enrollment in Part C beyond 2040,” according to a footnote.

The forecasters do not say what exactly the trustees think will happen to the Medicare Advantage program after 2040.

Related: Genworth exec: The LTC crisis is still coming

Green neon house

(Illustration: Thinkstock)

4. Hospitals, home health care providers and other inpatient service providers might have a so-so year in 2090.

The trustees think per-capita home health care spending might go up just 3.5 percent in 2090. That would be lower than the expected 3.8 percent increase in per-capita GDP, according to a discussion on Page 20 of the PDF file, or Page 14 by the trustees’ numbering.

Related: As population ages, it’s not your grandma’s ‘65 and older’

Purple planet

(Illustration: Thinkstock)

5. Physicians might want to schedule a trip to some other planet for 2090.

Physicians and outpatient services providers could do even worse than institutional providers in 2090. The trustees are predicting that per-capita spending on them will rise just 2.8 percent in 2090.


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