CONVERSION OF COUNTY PER CAPITA COSTS INTO RATES The "CHOICEYY.TXT" file for year YY (e.g. 99 for 1999 file) contains the monthly Medicare+Choice per capita rates of payment by county. For each county there will be six rates of payment (i.e. Aged Part A; Aged Part B; Disabled Part A; Disabled Part B; ESRD Part A; ESRD Part B). (see the Record Description below for the file layout). The Medicare+Choice methodology adjusts for age, sex, Medicaid status, working status, and institutional status of the Medicare beneficiaries in a given county. Also below are the tables containing the demographic cost factors used in this adjustment. Each factor relates the Medicare cost for a person in that demographic cell to the cost for the average Medicare beneficiary (Factor = 1.00). To calculate the actual per capita rates of payment, the rates in the CHOICEYY.TXT file must be multiplied by the demographic cost factors. The calculation of this monthly payment must be computed separately for Part A and Part B using the following steps: 1. Using the State and County of residence, select the appropriate standardized per capita rate (Aged, Disabled, or ESRD from the CHOICEYY.TXT file). 2. Using the tables of the demographic cost factors with the proper Part (A or B) and age group (10 categories), select the appropriate factor for the specific sex (male or female) and status (Institutionalized, Medicaid, Medicare, and Working Aged). 3. Multiply the rate (Step 1) by the factor (Step 2) to calculate the monthly payment. Note: Demographic adjustments are not made for ESRD enrollees. For these cases, the rate (Step 1) is the monthly payment. 1999 DEMOGRAPHIC COST FACTORS FOR THE AGED PART A - Hospital Insurance Sex and Institutional N o n - I n s t i t u t i o n a l Age Group Non- Working Medicaid Medicaid Aged Male: 85 & Over 2.25 2.60 1.35 .90 80 - 84 2.25 2.35 1.20 .80 75 - 79 2.25 1.95 1.05 .70 70 - 74 2.25 1.50 .85 .45 65 - 69 1.75 1.15 .65 .40 Female: 85 & Over 2.10 2.10 1.20 .80 80 - 84 2.10 1.70 1.05 .70 75 - 79 2.10 1.45 .85 .55 70 - 74 1.80 1.05 .70 .45 65 - 69 1.45 .80 .55 .35 PART B - Supplementary Medical Insurance Sex and Institutional N o n - I n s t i t u t i o n a l Age Group Non- Working Medicaid Medicaid Aged Male: 85 & Over 1.95 1.70 1.15 1.00 80 - 84 1.95 1.70 1.15 .90 75 - 79 1.95 1.55 1.10 .80 70 - 74 1.80 1.35 0.95 .65 65 - 69 1.60 1.10 .80 .45 Female: 85 & Over 1.65 1.25 1.00 .85 80 - 84 1.65 1.25 .95 .75 75 - 79 1.65 1.25 .95 .70 70 - 74 1.65 1.15 .85 .55 65 - 69 1.50 1.05 .70 .40 1999 DEMOGRAPHIC COST FACTORS FOR THE DISABLED PART A - Hospital Insurance Sex and Institutional N o n - I n s t i t u t i o n a l Age Group Non- Working Medicaid Medicaid Aged Male: 60 - 64 .60 1.85 1.00 N/A 55 - 59 .90 1.60 .85 N/A 45 - 54 1.10 1.30 .65 N/A 35 - 44 1.45 1.20 .70 N/A UNDER 35 1.80 1.10 .60 N/A Female: 60 - 64 .70 1.55 1.30 N/A 55 - 59 .95 1.35 .95 N/A 45 - 54 1.15 1.20 .75 N/A 35 - 44 1.40 1.20 .60 N/A UNDER 35 1.80 1.20 .55 N/A PART B - Supplementary Medical Insurance Sex and Institutional N o n - I n s t i t u t i o n a l Age Group Non- Working Medicaid Medicaid Aged Male: 60 - 64 .95 1.45 .95 N/A 55 - 59 1.10 1.30 .75 N/A 45 - 54 1.25 1.15 .60 N/A 35 - 44 1.50 1.15 .55 N/A UNDER 35 1.70 1.10 .45 N/A Female: 60 - 64 1.15 1.55 1.20 N/A 55 - 59 1.35 1.35 1.05 N/A 45 - 54 1.60 1.25 .95 N/A 35 - 44 1.85 1.15 .85 N/A UNDER 35 1.95 1.05 .75 N/A