Unbiased Analysis of Today's Healthcare Issues

Implicit Tax: Medicare as a Secondary Payer

Written By: Jason Shafrin - Oct• 10•07

“Medicare adopted its [Medicare as a Secondary Payer] MSP policy in 1982, effective January 1, 1983. This legislation states that for individuals working at firms with 20 or more employees, and otherwise eligible for Medicare benefits, Medicare serves as a secondary payer for health care expenses. The employer’s health insurance is the first payer. Because employer-sponsored health plans tend to be more comprehensive than Medicare, these workers are effectively foregoing their Medicare benefits by working. If these same individuals were not working, they would receive Medicare as their primary health insurance.”

A recent NBER working paper (“A Tax on Work for the Elderly: Medicare as a Secondary Payer“) claims that the MSP policy creates an implicit tax for elderly workers and thus creates disincentives to work. The authors calculate that the implicit tax is 15-20 percent at age 65 and increases to 45-70 percent by age 80. Making the Medicare the primary payer (MPP) will have two fiscal impacts. First, the cost of Medicare will increase. Since Medicare will be the primary payer, it will then be paying for more treatments. Secondly, enacting an MPP policy will decrease the implicit tax, increase the income and hours worked of elderly individuals and thus increase income tax receipts. The authors claim that since the second fiscal impact will dominate the first and thus recommend that an MPP system be implemented.

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