Include Medicare Part A and Part D premiums in SPM MOOP

changelog.d/8529.fixed.md

@@ -0,0 +1 @@
+- Included paid Medicare Part A premiums and Medicare Part D IRMAA surcharges in SPM-unit health insurance premiums and medical out-of-pocket expenses.

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

@@ -0,0 +1,19 @@
+- name: MSP Part A coverage pays the base premium for QMB enrollees.
+  period: 2025
+  input:
+    medicare_enrolled: true
+    is_qmb_eligible: true
+    base_part_a_premium: 6_216
+  output:
+    msp_part_a_premium_coverage: 6_216
+    medicare_part_a_premium: 0
+
+- name: MSP Part A coverage is zero for non-QMB enrollees.
+  period: 2025
+  input:
+    medicare_enrolled: true
+    is_qmb_eligible: false
+    base_part_a_premium: 6_216
+  output:
+    msp_part_a_premium_coverage: 0
+    medicare_part_a_premium: 6_216

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

@@ -6,6 +6,7 @@
         age: 70
         is_medicare_eligible: true
         other_health_insurance_premiums: 500
+        base_part_a_premium: 0
         medicare_part_b_premium: 2_220
     tax_units:
       tax_unit:
@@ -29,6 +30,7 @@
         age: 70
         is_medicare_eligible: true
         other_health_insurance_premiums: 500
+        base_part_a_premium: 0
         medicare_part_b_premium: 5_028
     tax_units:
       tax_unit:
@@ -43,3 +45,58 @@
   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 and Part D IRMAA premiums.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      retiree:
+        age: 70
+        is_medicare_eligible: true
+        is_qmb_eligible: false
+        other_health_insurance_premiums: 500
+        base_part_a_premium: 6_216
+        medicare_part_b_premium: 2_220
+        income_adjusted_part_d_premium_surcharge: 423.6
+    tax_units:
+      tax_unit:
+        members: [retiree]
+    spm_units:
+      spm_unit:
+        members: [retiree]
+    households:
+      household:
+        members: [retiree]
+        state_code: CA
+  output:
+    spm_unit_health_insurance_premiums: 9_359.6
+    spm_unit_medical_out_of_pocket_expenses: 9_359.6
+
+- name: SPM unit MOOP excludes Part A premiums covered by MSP.
+  period: 2025
+  absolute_error_margin: 0.01
+  input:
+    people:
+      retiree:
+        age: 70
+        is_medicare_eligible: true
+        other_health_insurance_premiums: 500
+        base_part_a_premium: 6_216
+        msp_part_a_premium_coverage: 6_216
+        medicare_part_b_premium: 2_220
+        income_adjusted_part_d_premium_surcharge: 423.6
+    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: 3_143.6
+    spm_unit_medical_out_of_pocket_expenses: 3_143.6

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

@@ -0,0 +1,22 @@
+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/help/medicare-savings-programs",
+    )
+    documentation = (
+        "Annual Medicare Part A premium paid out of pocket by the enrollee, "
+        "net of Medicare Savings Program coverage."
+    )
+
+    def formula(person, period, parameters):
+        gross_premium = person("base_part_a_premium", period)
+        msp_coverage = person("msp_part_a_premium_coverage", period)
+        return max_(gross_premium - msp_coverage, 0)

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

@@ -0,0 +1,30 @@
+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",
+        "https://www.law.cornell.edu/uscode/text/42/1396d#p_3",
+    )
+    documentation = (
+        "Annual Part A premium amount paid on the enrollee's behalf through "
+        "the Qualified Medicare Beneficiary pathway."
+    )
+
+    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

@@ -18,5 +18,7 @@ class spm_unit_health_insurance_premiums(Variable):
         "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, Medicare Part A "
+        "and Part B net of Medicare Savings Program coverage, and Medicare "
+        "Part D IRMAA premiums. Non-premium expenses include other medical "
+        "expenses and over-the-counter health expenses."
     )
 
     adds = [