Include Medicare Part A premiums and Part D IRMAA in MOOP

changelog.d/8529.fixed.md

@@ -0,0 +1 @@
+Include paid Medicare Part A premiums and Part D IRMAA in SPM medical out-of-pocket expenses.

policyengine_us/tests/policy/baseline/gov/hhs/medicare/eligibility/medicare_part_a_premium.yaml

@@ -0,0 +1,26 @@
+- name: Medicare Part A premium equals base premium when no MSP coverage.
+  period: 2026
+  input:
+    medicare_enrolled: true
+    base_part_a_premium: 6_780
+    msp_part_a_premium_coverage: 0
+  output:
+    medicare_part_a_premium: 6_780
+
+- name: Medicare Part A premium is net of MSP coverage.
+  period: 2026
+  input:
+    medicare_enrolled: true
+    base_part_a_premium: 6_780
+    msp_part_a_premium_coverage: 6_780
+  output:
+    medicare_part_a_premium: 0
+
+- name: Medicare Part A premium floors at zero after MSP coverage.
+  period: 2026
+  input:
+    medicare_enrolled: true
+    base_part_a_premium: 6_780
+    msp_part_a_premium_coverage: 7_000
+  output:
+    medicare_part_a_premium: 0

policyengine_us/tests/policy/baseline/gov/hhs/medicare/savings_programs/msp_part_a_premium_coverage.yaml

@@ -0,0 +1,26 @@
+- name: MSP Part A coverage pays the Part A premium for QMB enrollees.
+  period: 2026
+  input:
+    medicare_enrolled: true
+    is_qmb_eligible: true
+    base_part_a_premium: 6_780
+  output:
+    msp_part_a_premium_coverage: 6_780
+
+- name: MSP Part A coverage is zero for non-QMB enrollees.
+  period: 2026
+  input:
+    medicare_enrolled: true
+    is_qmb_eligible: false
+    base_part_a_premium: 6_780
+  output:
+    msp_part_a_premium_coverage: 0
+
+- name: MSP Part A coverage is zero when not enrolled.
+  period: 2026
+  input:
+    medicare_enrolled: false
+    is_qmb_eligible: true
+    base_part_a_premium: 6_780
+  output:
+    msp_part_a_premium_coverage: 0

policyengine_us/tests/policy/baseline/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses_medicare_part_b.yaml

@@ -43,3 +43,55 @@
   output:
     spm_unit_health_insurance_premiums: 5_528
     spm_unit_medical_out_of_pocket_expenses: 5_528
+
+- name: SPM unit MOOP includes paid Part A premium and Part D IRMAA.
+  period: 2026
+  input:
+    people:
+      retiree:
+        age: 70
+        medicare_enrolled: true
+        other_health_insurance_premiums: 500
+        base_part_a_premium: 6_780
+        msp_part_a_premium_coverage: 0
+        medicare_part_b_premium: 4_654.80
+        income_adjusted_part_d_premium_surcharge: 423.60
+    tax_units:
+      tax_unit:
+        members: [retiree]
+    spm_units:
+      spm_unit:
+        members: [retiree]
+    households:
+      household:
+        members: [retiree]
+        state_code: CA
+  output:
+    medicare_part_a_premium: 6_780
+    spm_unit_health_insurance_premiums: 12_358.40
+    spm_unit_medical_out_of_pocket_expenses: 12_358.40
+
+- name: SPM unit MOOP excludes QMB-covered Part A premium.
+  period: 2026
+  input:
+    people:
+      retiree:
+        age: 70
+        medicare_enrolled: true
+        base_part_a_premium: 6_780
+        msp_part_a_premium_coverage: 6_780
+        medicare_part_b_premium: 2_434.80
+    tax_units:
+      tax_unit:
+        members: [retiree]
+    spm_units:
+      spm_unit:
+        members: [retiree]
+    households:
+      household:
+        members: [retiree]
+        state_code: CA
+  output:
+    medicare_part_a_premium: 0
+    spm_unit_health_insurance_premiums: 2_434.80
+    spm_unit_medical_out_of_pocket_expenses: 2_434.80

policyengine_us/variables/gov/hhs/medicare/eligibility/part_a/medicare_part_a_premium.py

@@ -0,0 +1,20 @@
+from policyengine_us.model_api import *
+
+
+class medicare_part_a_premium(Variable):
+    value_type = float
+    entity = Person
+    label = "Medicare Part A premium"
+    unit = USD
+    definition_period = YEAR
+    defined_for = "medicare_enrolled"
+    reference = "https://www.medicare.gov/basics/costs/medicare-costs"
+    documentation = (
+        "Annual Medicare Part A premium paid out of pocket by the enrollee, "
+        "net of Medicare Savings Program coverage."
+    )
+
+    def formula(person, period, parameters):
+        base_premium = person("base_part_a_premium", period)
+        msp_coverage = person("msp_part_a_premium_coverage", period)
+        return max_(base_premium - msp_coverage, 0)

policyengine_us/variables/gov/hhs/medicare/savings_programs/msp_part_a_premium_coverage.py

@@ -0,0 +1,29 @@
+from policyengine_us.model_api import *
+
+
+class msp_part_a_premium_coverage(Variable):
+    value_type = float
+    entity = Person
+    unit = USD
+    label = "Medicare Part A premium amount covered by MSP"
+    definition_period = YEAR
+    reference = (
+        "https://www.medicare.gov/basics/costs/help/medicare-savings-programs",
+    )
+    documentation = (
+        "Annual Part A premium amount paid on the enrollee's behalf through "
+        "Qualified Medicare Beneficiary coverage."
+    )
+
+    def formula(person, period, parameters):
+        enrolled = person("medicare_enrolled", period)
+        monthly_part_a_premium = person("base_part_a_premium", period) / MONTHS_IN_YEAR
+        monthly_coverage = 0
+        for month in period.get_subperiods(MONTH):
+            qmb_eligible = person("is_qmb_eligible", month)
+            monthly_coverage += where(
+                enrolled & qmb_eligible,
+                monthly_part_a_premium,
+                0,
+            )
+        return monthly_coverage

policyengine_us/variables/household/income/spm_unit/spm_unit_health_insurance_premiums.py

@@ -10,13 +10,16 @@ class spm_unit_health_insurance_premiums(Variable):
     documentation = (
         "Health insurance premium expenses for an SPM unit, combining a "
         "data-imputed other premium component with modeled premium components "
-        "that can respond to policy reforms."
+        "that can respond to policy reforms, including Medicare premiums "
+        "paid out of pocket."
     )
 
     adds = [
         "other_health_insurance_premiums",
         "chip_premium",
         "medicaid_premium",
         "marketplace_net_premium",
+        "medicare_part_a_premium",
         "medicare_part_b_premium",
+        "income_adjusted_part_d_premium_surcharge",
     ]

policyengine_us/variables/household/income/spm_unit/spm_unit_medical_out_of_pocket_expenses.py

@@ -11,10 +11,10 @@ class spm_unit_medical_out_of_pocket_expenses(Variable):
         "Total medical out-of-pocket expenses at the SPM unit level, "
         "combining health insurance premiums with non-premium medical "
         "expenses. Health insurance premiums include other health insurance "
-        "premiums plus modeled Marketplace, CHIP, Medicaid, and Medicare Part "
-        "B premiums net of Medicare Savings Program coverage. Non-premium "
-        "expenses include other medical expenses and over-the-counter health "
-        "expenses."
+        "premiums plus modeled Marketplace, CHIP, Medicaid, and Medicare "
+        "premiums net of Medicare Savings Program coverage where modeled. "
+        "Non-premium expenses include other medical expenses and "
+        "over-the-counter health expenses."
     )
 
     adds = [