The 2021 SIPP asks several questions about deductions for Medicare premiums (variables TSSPARTBAMT, TSSPARTCAMT, and TSSPARTDAMT). In the Medical Expenditures question series, SIPP also asks about out-of-pocket expenditures for health insurance premiums (variable THIPAYC). This question is intended to capture health insurance premiums excluding Medicare premiums deducted from Social Security. An instruction is included following the main question text as shown below.

Question Text for variable THIPAYC:

Last year, how much did (NAME) pay out-of-pocket for comprehensive health insurance premiums covering (self) or others in the household?

(optional text:) Comprehensive health insurance plans are insurance plans that cover basic healthcare needs and cover a wide range of services.

(if they previously reported deductions from Social Security Income for Medicare Part B, C, or D premiums, then include this additional text:) Please DO NOT include previously reported premium expenditures for Medicare Parts B, C, or D deducted from Social Security Income.

The 2014 SIPP Panel also asked about out-of-pocket expenditures, but with some key differences in question structure. However, the Panel 2014 question on health insurance premium expenditures (THIPAY) also included the same instruction to exclude deducted Medicare premiums. For more information about the 2014 SIPP Panel versus the 2018 SIPP onward question wording, please refer to the 2018 SIPP Users’ Guide (section 4.3.6 Health Care Utilization and Medical Expenditures) at https://www2.census.gov/programs-surveys/sipp/tech-documentation/methodology/2018_SIPP_Users_Guide.pdf