Department  of Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
Medicare  Beneficiaries  With  Additional 
Medical  Insurance  in  1997 
JUNE  GIBBS  BROWN 
Inspector  General 
JULY1998 
OEI-04-97-00031  OFFICE  OF INSPECTOR  GENERAL 
The mission  of the Office  of Inspector  General (OIG),  as mandated by Public  Law  95-452,  is to 
protect  the integrity  of the Department  of Health  and Human  Services programs  as well  as the 
health and welfare  of beneficiaries  served by them.  This statutory  mission  is carried out through 
a nationwide  program  of audits, investigations,  inspections,  sanctions, and fraud alerts.  The 
Inspector  General informs  the Secretary of program  and management problems  and recommends 
legislative,  regulatory,  and operational  approaches to correct them. 
Office  of Evaluation  and Inspections 
The Office  of Evaluation  and Inspections  (OEI)  is one of several components  of the Office  of 
Inspector  General.  It conducts  short-term  management  and program  evaluations  (called 
inspections)  that focus on issues of concern to the Department,  the Congress, and the public.  The 
inspection  reports provide  findings  and recommendations  on the efficiency,  vulnerability,  and 
effectiveness of departmental  programs. 
OEIs Atlanta  Regional  Office  prepared this report under the direction  of Jesse J. Flowers, 
Regional  Inspector  General, and Christopher  Koehler,  Deputy  Regional  Inspector  General. 
Principal  OEI staff included: 
ON  RTERS 
Betty  Apt, Project  Leader 
 Wynethea  Walker,  Program  Specialist 
Jason Stanfield,  Contractor 
 Linda  Moscoe,  Technical  Support 
Joe Townsel,  Program  Analyst 
 Barbara Tedesco, Statistician 
Paula Bowker,  Program  Analyst 

Greg Jones, Program  Analyst 

Janet Miller,  Program  Analyst 

To obtain copies of this report, please call the Atlanta Regional Office at 404-562-7743 
Reports  are also available  on the World  Wide Web at our home page address: 
http:flwww.dhhs.govlprogorg/oei  PAGE 

EXECUTIVE  SUMMARY 

INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..l 
FINDINGS 
Most  Beneficiaries  Have Additional  Insurance  . . . . . . . . . . . . . . . . . . . . . . . . . 2 
Most  Beneficiaries  Are  Satisfied  with  Insurance  . . . . . . . . . . . . . . . . . . . . . . . . . 3 
APPENDICES 
Beneficiary  Responses  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A- 1 
Confidence  Intervals  . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  B-1  PURPOSE 
To determine  how  many beneficiaries  have medical  insurance  that supplements  Medicare,  and 
if they are satisfied  with  the insurance. 
BACKGROUND 
Medicare  is a Federal  health  insurance  program  for  individuals  age 65 and older,  and for 
certain  categories  of disabled  people.  In Calendar  Year  1997, Medicare  served over 38 million 
people,  known  as beneficiaries,  and paid benefits  of approximately  $211 billion. 
During  our  1997 survey  of Medicare  beneficiary  satisfaction,  we asked 977 beneficiaries  about 
their  satisfaction  with  insurance  that supplements  their  Medicare  coverage.  Several people  in 
the Health  Care Financing  Administration  expressed an interest  in this subject when  we 
conducted  our  1995 beneficiary  satisfaction  survey,  and suggested questions  for us to include. 
We kept those questions  in our  1997 survey  . 
In July  1997,  we mailed  a questionnaire  to 1269 randomly-selected  Medicare  beneficiaries  for 
whom  Part B claims had been filed  in Calendar  Year  1996.  We excluded  from  our sample 
beneficiaries  who  were  enrolled  in an HMO.  A total  of 977 beneficiaries  returned  completed 
questionnaires,  for  a response rate of 77 percent. 
We compared  responses to our  1995 and 1997 surveys,  and determined  statistically  significant 
differences  through  use of a t-test. 
We conducted  this inspection  in accordance  with  the Quality  Standards for  Inspections  issued 
by the Presidents  Council  on Integrity  and Efficiency. 
Health  Care Financing  Administration,  United  States Department of Health and Human Services, HCEA 
Statistics, October 1997. 
1  EIGHTY-SIX  PERCENT  OF BENEFICIARIES  REPORT  THEY  HAVE  MEDICAL 
INSURANCE  IN  ADDITION  TO  MEDICARE 
In  1997, 86 percent  of the beneficiaries  said they have medical  insurance  coverage  in addition 
to Medicare.  This  is about the same as in  1995, when  84 percent  said they had other 
insurance  coverage. 
Table  1 shows the types of  insurance  Medicare  beneficiaries  said they have.  The percentages 
in  1997 are about the same as in  1995 except for  Medigap  insurance,  i.e.,  insurance  obtained 
by Medicare  beneficiaries  directly  from  private  sources.  The increase in the percent  of 
beneficiaries  who  had private  Medigap  policies  from  1995 to 1997 was statistically  significant. 
Table  1 

Types  of Medical  Insurance  Medicare  Beneficiaries  Have 

Insurance Through Current or Former Employer 
Current Employer 
Former Employer 
Private Medicare Supplemental (Medigap) 
Medicaid 
Other 
Somebeneficiaries said they have more than one type of insurance. 

In 1995, we combined the question about insurance through current andformer  employment. 

The increase in the number of beneficiaries with Medigap insurance is statistically significant. 

Although the number of beneficiaries with Medicaid decreased 3 percent, the decrease is not 

statistically significant. 

2 
 EIGHTY-EIGHT  PERCENT  OF BENEFICIARIES  ARE  SATISFIED  WITH  THEIR 
ADDITIONAL  INSURANCE 
As shown  in Figure  1, 88 percent  of beneficiaries  who  have insurance  policies  that supplement 
Medicare  said they are satisfied  with  them.  Only  6 percent  are dissatisfied. 
Figure  1 
Beneficiary  Satisfaction  with 
Supplemental  Health  Insurance 
35% 
q 
.  Very  Satisfied 53% 
q Generally Satisfied 35% 
. 	 Neither Satisfied nor 
Dissatisfied  6% 
q Generally Dissatisfied  4% 
q Very  Dissatisfied  2% 
Figure  1 represents the responses of beneficiaries  who  have either 
Medigap  or insurance through  former  or current  employers. 
Table 2 shows that satisfaction  with  insurance  that supplements  Medicare  has not changed 
since 1995. 
Table  2 
Satisfaction  with  Insurance  That  Supplements  Medicare  APPENDIX  A 
RESPONSES  TO  1997 SURVEY  OF BENEFICIARIES 
Question  Number  of  Responses 
1.  What  types  of medical  insurance  do you  or your  spouse have in addition  to 
Medicare? 
(Check  all that  apply.) 
(N = 907 - Number  Responding  to Question) 
I do not have additional 
insurance coverage  127 
Medicaid  (or other State or 
county  medical  assistance 
program)  85 
Health  insurance through  you or 
your  spouses current  employer  58 
Health  insurance through  you or 
your  spouses former  employer  321 
Private Medicare  supplement 
(Medigap)  347 
Other  7 
Not Answering:  70 
A-l  Question  Number  of Responses 
2.  How  satisfied  are you  with  your  private  Medicare  supplemental  insurance? 
(Check  one.) 
(N = 504 - Number  Who  Had  Medigap  or Insurance  Through  Current  or Previous 
Employment  and Responded  to Question) 
Very  Satisfied  268 
Generally  Satisfied  178 
Neither  Satisfied 
nor Dissatisfied  30 
Generally  Dissatisfied  20 
Very  Dissatisfied  8 
Not Answering:  72 
A-2 
 APPENDIX  B 
CONFIDENCE  INTERVALS 
FINDING  #l 	 Eighty-six  percent  of beneficiaries  report  they  have medical  coverage  in 
addition  to Medicare. 
Estimate  Boundaries  for  the 95%
Description 
Confidence  Intervals 
1997 
Beneficiaries  with  Additional  Coverage:  86%  +I- 2.3% 
Insurance through  Current  or Former 
Employer  41%  +I- 3.2% 
Current  Employer  6%  +/- 1.5% 
Former  Employer  35%  +/- 3.1% 
Private Supplemental  (Medigap)  38%  +I- 3.2% 
Medicaid  9%  +/- 1.9% 
Other  1%  +/- .6% 
Beneficiaries  with  No Added  Coverage  16%  +I- 2.3% 
Beneficiaries  with  Additional  Coverage:  84%  +I- 2.5% 
Insurance through  Current  or Former 
Employer  42%  +I- 3.4% 
Private Supplemental  (Medigap)  32%  +I- 3.2% 
Medicaid  12%  +/- 2.3% 
Other  1%  +I- .7 
Beneficiaries  with  No Added  Coverage  16%  +/- 2.5% 
B-l  FINDING  #2  Eighty-eight  percent  of beneficiaries  are satisfied  with  additional  coverage. 
Description  Estimate  Boundaries  for  95% 
Confidence  Interval 
Beneficiaries  satisfied with  additional 

medical  coverage.  88%  +/- 2.8% 

B-2