SPOTTED SKIN IN THE GAME:

Payroll-tax revenue covers most of the cost of Part A hospital care. The coverage has a $1,184 annual deductible for care, but beneficiaries don't have to pay further cost-sharing on the first 60 days of a hospital stay. Copayment charges increase sharply after that.

The majority of beneficiaries also sign up for Part B coverage of doctor bills, with basic premiums set at $104.90 a month, and a $147 annual deductible and 20% cost-sharing. There are no caps on the amount that they pay out of pocket.

A deficit-reduction panel chaired by Republican Alan Simpson and Democrat Erskine Bowles recommended in late 2010 that the deductibles be combined into a single $550 deductible, with seniors asked to contribute 20% toward the cost of hospital and doctor care until they reach a cap.

Under the cap, beneficiaries would pay a much smaller share after the first $5,500 of costs and no more than $7,500 out of pocket in total.

The combined effect of the changes, the panel predicted, could save the U.S. $10 billion in 2015 and $110 billion through 2020.

That would help seniors who get very sick, but the savings would come because the majority of seniors would pay more out of pocket.

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