Medicare utilization by disabled-worker beneficiaries: a longitudinal analysis

Medicare eligibility for Social Security disabled-worker beneficiaries begins after 2 years of cash benefit receipt. Extension of the current coverage is often proposed as a way to encourage beneficiaries to return to work. Little is known, however, about the long-run Medicare costs for the disabled and how costs vary by demographic and health characteristics. This article describes Medicare utilization and reimbursement amounts for 1974-81 for a cohort of disabled-worker beneficiaries under age 62 and first entitled to cash benefits in 1972. The data come from a first-time linkage of Disability Insurance program data with data on Medicare utilization. The tables provide a detailed look at several factors that are associated with variation in Medicare costs among beneficiaries and over time.     

Comparison of individual characteristics and death rates of disabled-worker beneficiaries entitled in 1972 and 1985.

The many changes to the Disability Insurance (DI) program that took place during the early 1980's suggest that there may be significant differences in the characteristics of newly awarded beneficiaries over time. This study compares two cohorts of newly entitled beneficiaries--one from 1972 and the other from 1985--in order to assess changes in individual characteristics and death rates between the pre-1980's and the late 1980's. The 1985 cohort had a greater percentage of beneficiaries with mental impairments and a lower percentage with diseases of the circulatory system. The 1985 cohort was also younger, more educated, had higher primary insurance amount levels, and had greater percentages of women and black beneficiaries. Although the death rates and survival curves for both cohorts were very similar, differences in the curves occurred for some covariate subgroups. When the populations were standardized, the estimated percentages of beneficiaries who survived 5 years after entitlement were 78 percent for the 1972 cohort and 77 percent for the 1985 cohort.     

Income of new disabled-worker beneficiaries and their families: findings from the New Beneficiary Survey

In 1982, disabled workers who came on the social security disability insurance rolls from mid-1980 to mid-1981 had median monthly incomes of less than $500 if they were unmarried and less than $1,300 if they were married. These median monthly income levels, which include the income of a spouse and minor children if present, are roughly half those of the noninstitutionalized population aged 25-64. Social security benefits are the most important source of income for disabled workers and their families: They account for 40 percent of the total family income of married disabled workers and 65 percent of the total income of unmarried disabled workers. Social security benefits provide at least half of all income for more than 80 percent of unmarried disabled-worker beneficiaries and for 50 percent of the married beneficiaries. For married disabled-worker beneficiaries, earnings of the spouse are the second most important income source. Spousal earnings account for 28 percent of total income. Pensions and asset income each account for about 10 percent of total income for these married beneficiaries. Earnings are not an important source of income for unmarried disabled-worker beneficiaries for whom they amount to only about 3 percent of total income. Pensions, asset income, and public transfers each account for about 10 percent of total income of the unmarried beneficiaries.     

Expanding access to health care for Social Security Disability Insurance beneficiaries: early findings from the accelerated benefits demonstration

Most Social Security Disability Insurance (DI) beneficiaries must complete a 5-month waiting period before they become entitled to DI cash benefits and an additional 24-month waiting period before Medicare benefits begin. The Accelerated Benefits (AB) demonstration is a randomized experiment designed to test the effects of providing newly entitled DI beneficiaries who do not have health insurance with a generous health benefits package during the Medicare waiting period. This article presents early findings on the prevalence of health insurance coverage among newly entitled beneficiaries and the characteristics of those without health insurance. It also examines the effects of AB on health care utilization, the extent to which AB reduces unmet medical needs, and the costs of providing the AB health benefits package.     

Income and assets of Social Security beneficiaries by type of benefit

The SIPP data have provided a first look at the relative economic status of various types of Social Security beneficiaries. They have shown that the different types of Social Security beneficiaries face very different economic circumstances. Retired workers and wife beneficiaries have the highest family incomes adjusted for family size. Aged widows and minor children have the lowest family incomes, with high proportions of poor or near poor. And disabled workers are in between, but also have high proportions of poor or near poor. Retired-worker and wife beneficiary households also have considerably more asset holdings than disabled-worker or widow beneficiary households. Beneficiaries with high family incomes are very likely to live with relatives and to rely heavily on the relatives' income. The high-income families tend to have non-means-tested sources of family income other than Social Security amounting to substantial proportions of their total income and to have high asset holdings. Conversely, beneficiaries with low family incomes are very likely to live alone or with nonrelatives, to rely heavily on Social Security and means-tested benefits, and to have low asset holdings. A majority of ever-poor beneficiaries (with the exception of widow beneficiaries) are poor in only some months of a year. This situation is not consistent with the stereotype of beneficiaries living on fixed incomes. But the change in poverty status is often due to a change in the income of other family members rather than of the beneficiary. And in some cases, a change in poverty status occurs with little or no change in income as the cost of living rises.     

The reservation wages of Social Security Disability Insurance beneficiaries

There exists a lot of research on the reservation wages of the unemployed as a determinant of unemployment duration. Little is known about the reservation wages of those who are not in the labor force but might be potential labor force returnees, such as Social Security Disability Insurance (DI) beneficiaries. The main objective of this article is to assess what can be learned from the subjective reservation wages of DI beneficiaries. Using the New Beneficiary Data System (NBDS), the article assesses the magnitudes of reservation wages compared to the last wage earned and the benefit amount, as well as the determinants of reservation wages in a regression framework. The NBDS is unique in that it provides the reservation wages and the work history of DI beneficiaries before and after joining the DI rolls. The article has several noteworthy results and policy implications: *Data show that a significant portion of beneficiaries report being likely to accept a job if offered one. Based on the NBDS, 13 percent of DI beneficiaries who did not work since joining the rolls in 1981-1982 reported in 1991 that they would be willing to work if offered a job and provided their reservation wages. *DI beneficiaries do not appear to price themselves out of the labor market. Half of them would want a wage that is 80 percent or less of the last wage earned before receiving DI. It is estimated that approximately 7 percent of long-term DI beneficiaries may potentially return-to-work if they search for jobs and have a wage offer distribution with a mean at 80 percent of their last wage. *The nonlabor income in addition to the benefit is positively and significantly associated with the reservation wage, while the benefit amount per se is not. However, this result needs to be treated with caution given that nonlabor income is endogenous to the model. *Heterogeneity exists between persons still under the DI program and those that have moved to the Old-Age program. The subsamples of persons who have shifted to the Old-Age program and those who are still under the DI program have median reservation wage to the last wage ratios of 0.69 and 0.93, respectively. A significantly lower reservation wage for persons who have moved to the Old-Age program was also found in a regression framework. This heterogeneity between the two groups may result in part from the different program characteristics both groups face, for instance, in terms of benefit termination and Medicare eligibility rules. *Subjective reservation wage data can be useful to study populations that are out of the labor force. This article is innovative in that it focuses on a group of persons who are typically considered as being out of the labor force, and therefore are not asked reservation wages in general household surveys such as the Current Population Survey. It would be of great interest to collect more reservation wage data for DI beneficiaries in a longitudinal data set to expand this analysis, for instance, to assess conclusively the effects of changing program characteristics on reservation wages and return-to-work outcomes as beneficiaries transition to the Old-Age program or as new return-to-work programs are put in place.     

Ineligible spouses of SSI beneficiaries, December 1976.

A study based on program records showd that about 200,000 persons receiving supplemental security income (SSI) payments in December 1976 were living with a spouse who was not eligible for payments. In most cases, the beneficiaries were disabled and the spouses were too young to be eligible. Some spouses were receiving help indirectly from the program through the essential-person increment, State supplementary payments, or the deeming-of-income provision. Fewer than half the spouses had income of their own, however, and even when the income of both partners was combined, 55,000 households had no income other than the SSI payment. A sizable number of families included dependent children and thus may have been eligible for aid to families with dependent children.     

Earnings histories of SSI beneficiaries working in December 1997.

Disabling conditions previously considered to be permanent and total are no longer viewed as automatic barriers to work. Medical advances, improved accommodations in the workplace, and changes in the nature of work for the working disabled have allowed many disabled people to rejoin the workforce. The Social Security Administration (SSA) has followed those developments with a view toward encouraging people receiving disability benefits to consider returning to work. To effectively target SSA's efforts and evaluate their success, information about previous work histories of the Supplemental Security Income (SSI) beneficiary population is used to provide baseline data. This article examines the earnings histories of 300,000 disabled SSI beneficiaries--one of the populations targeted by the expanded work-incentive measure under Public Law 106-70--who were working in December 1997. The article also investigates whether beneficiaries who are working have significant lifetime earnings and whether earnings patterns exist that might assist with SSA's work-support activities. SSI program records were matched to data in the Master Earnings File to explore the characteristics and earnings patterns before and after a person applies for benefits. The article addresses several questions: What are the general characteristics of disabled SSI beneficiaries? What are their earnings histories? Did they have an earnings record when they applied for SSI? Of the SSI beneficiaries working in December 1997, most tended to be younger than other disabled beneficiaries, to have some sort of mental disability, and to have earnings well below levels that would suggest their eventual, complete independence from the SSI cash benefits program. A look at past covered earnings revealed that the vast majority of SSI workers had a history of earnings before they applied for SSI benefits. Despite their severe impairments and age at the time of first eligibility, nearly 40 percent had earnings in 11 years or more. The amounts of those earnings were quite low, however, and were usually not high enough to preclude SSI eligibility. Examining the years immediately before and after the point of application indicated whether recent pre-application earnings were consistent with post-application return to work. Results were a bit surprising. They revealed that one-third of the 1997 SSI workers had no earnings, and another 28 percent returned to work despite having no earnings in the 4-year period before application. Persons receiving SSI because of mental retardation seemed to have poorer earnings histories than other workers but were more likely to return to work after application. That may be explained by their younger ages or may reflect the outside assistance they received in responding to SSA work incentives.     

Comparing beneficiaries of the Medicare savings programs with eligible nonparticipants

This note focuses on participation in two entitlement programs that help reduce out-of-pocket expenses for low-income Medicare beneficiaries: the Qualified Medicare Beneficiary (QMB) program and the Specified Low-Income Medicare Beneficiary (SLMB) program. As of 1999, about 2.75 million eligible, noninstitutionalized individuals were not enrolled in these Medicare savings programs. The eligible nonparticipants differed substantially from the QMB and SLMB participants in that they were less likely to be Supplemental Security Income beneficiaries and more likely to be elderly, nonblack, and in relatively good health. These findings, which could help target future outreach efforts, are based on Survey of Income and Program Participation data matched with administrative records from the Social Security Administration.     

Educational and economic characteristics of student beneficiaries: black-white differences

This article compares black and white student beneficiaries under the old-age, survivors, and disability insurance (OASDI) program during the 1972-73 school year from the standpoint of differences in economic and educational characteristics. The role that OASDI played in enabling students to continue in school full time is studied. The findings show that relatively more blacks were in the student beneficiary population than in the general student population; they were also overrepresented among students attending high school. Blacks were disadvantaged with respect to the educational attainment of their fathers and in terms of total family income. They also had lower-grade-point averages and those in high school were older than their white counterparts. Black high school students nevertheless planned to continue their education and to attend 4-year colleges in about the same proportion as whites. The total amount of educational income of black students was greater than that of white students, but the members of the latter group received more from loans and miscellaneous sources. Grants were the most important source of educational income for blacks. About half the student beneficiaries said they could continue full time in school without benefits and a third said they could not.     

Projections of economic well-being for Social Security beneficiaries in 2022 and 2062

Policymakers considering potential changes to the Social Security program need to be able to assess how such changes would affect the economic well-being of future retirees. The first step to understanding these effects is to determine the well-being of future retirees under the current Social Security system. To this end, this article projects the retiree populations aged 62 or older in 2022 and 2062 using the Social Security Administration's MINT (Modeling Income in the Near Term) model and assesses their well-being. Because no one measure can fully capture whether future retirees will have adequate resources to meet their needs, we employ several indicators to assess retirement prospects. In addition, because current-law Social Security promises cannot be financed from current-law taxes, we project an alternative 2062 baseline that adjusts Social Security benefits downward to reflect the amounts that current-law taxes can support. Our results illustrate the importance of using several measures when assessing the well-being of future Social Security beneficiaries. When using absolute measures, retirement well-being will improve for Social Security beneficiaries in 2062 compared with those in 2022. Median per capita income of Social Security beneficiaries is projected to increase by a third (in real terms) between 2022 and 2062, with a corresponding decline in projected poverty rates. In addition, median financial wealth will increase between 2022 and 2062. Relative measures of well-being, however, suggest a decline in well-being between Social Security beneficiaries in 2022 and those in 2062. The share of beneficiaries who have low income relative to their peers, measured as the share whose income-to-needs ratio is less than half of the median ratio, will increase over time. In addition, income replacement rates are projected to fall between 2022 and 2062, indicating a decline in how well-being during retirement compares with that during the working years. And although median financial wealth will increase between 2022 and 2062, it will actually fall relative to economy-wide average wages. Projected improvements over time would lessen, and declines would be exacerbated, if instead of assuming the payment of currently scheduled Social Security benefits we assumed that benefits would be reduced according to what is payable under current-law taxes. Regardless of which measure of well-being is used, certain groups fare worse than others, including beneficiaries who never married, nonwhites, beneficiaries without a high school degree, and those with fewer years of labor force experience and low lifetime earnings. These vulnerable groups are likely to be more dependent on Social Security benefits for their retirement income. As a result, they fare particularly poorly under the assumption that Social Security benefits are reduced to reflect what is payable under current-law taxes.     

Seeing Spots: Partisanship,Negativity and the Conditional Receipt of Campaign Advertisements

Changes in the media landscape increasingly put voters in control of the amount and type of political content they consume. We develop a novel experiment to assess the factors that drive this conditional receipt of information. We focus on how party source and tone interact with partisanship to influence the campaign messages voters seek out or avoid, as discretion over self-exposure varies. We randomly expose subjects to comparable positive or negative television ads aired by Democratic or Republican candidates from the 2012 Presidential election, and measure subjects’ propensities to skip, re-watch and share the spots. Partisans avoid out-party ads, albeit asymmetrically: Republicans are more consistent partisan screeners than Democrats. We find more such selectivity as discretion increases, but little evidence that negativity influences self-exposure. Our findings provide greater insight into the forces behind information selectivity, and have important implications for elections in the post-broadcast era.     

Assets of new retired-worker beneficiaries: findings from the New Beneficiary Survey

Most new retired workers in 1982 owned some type of asset, usually a savings, checking, or credit union account, according to data obtained by the Social Security Administration (SSA) in its New Beneficiary Survey. Many recently retired workers also owned their home, often mortgage-free. Homeownership was their most significant asset in terms of its median value. Comparatively few retirees owned property other than a home, though for owners of such property, the median value was substantial. Married couples, whose assets included those of both partners, more frequently owned assets and their assets had higher median values than did unmarried individuals. A comparison of retired workers with persons aged 65 or older who were enrolled in the Medicare program but who had not yet received retired-worker benefits showed that these Medicare-only enrollees were much better off, both in the likelihood of owning assets and in having higher median values for their assets. Individuals who retired before reaching age 65 and therefore received a reduced social security benefit were not as well off as those whose first benefit was paid at age 65 or older. Overall, the asset situation of new retired workers in 1982 was better than that of men and unmarried women aged 58-63 in 1969, even when the 1969 assets were adjusted to constant 1982 dollars.     

The Social Security Administration's 10-percent sample file of OASDI beneficiaries.

This is another in a series of technical articles describing Social Security Administration sample files and statistical systems. The focus of this article is the 10-percent sample file that provides program and demographic information on Social Security beneficiaries under the Old-Age, Survivors, and Disability Insurance program. The article explains the contents and availability of the 10-percent sample and presents several statistical tabulations as examples of the wide variety of data that can be developed from the file.