GERO FINAL medicare and medicaid
u can pay _____ of tax and receive benefits early but with ____ you have to reach FULL RETIREMENT AGE
13.3%, Medicare
the SS Act was passed in ___ and what did it state?
1935, pay-as-you-go system gov gives certain money to old ppl but still paying out of pocket for dr. Health care was on a fee-for-service basis Out-of-pocket basis
if you were born _______ and later, the age where you will get medicare is 67!!!
1960 and later
in ____ there was an ___ to the SS Act passed which said what?
1965, amendment, Medicare, Medicaid, and Supplemental Security Income (SSI) The federal government is the primary payer
MEDICARE D began in ____
2006
Medicare spending accounts for _____% of total national health spending
23%
MEDICARE B accounts for OVER ___% of spending in 2010!!!
27%
___% of americans have the stand alone PDP (prescription drug plan)
38%
ONLY 10% of Americans which is _____ mill have NO DRUG COVERAGE
4.7
older pop proportion is ____% which is 1 in 5 people
40%
Medicare covered nearly _____ million Americans in 2011. 84% of beneficiaries are seniors 16% are under age 65. 4.8 million in CA
47.6
FOR MEDICARE A COVERAGE, the In-patient hospitalization Benefit period is _____ days
60 (2 months)
In 2010, ___% of Medicare beneficiaries enrolled in Medicare D
60%
If you were born in 1937 or earlier, you will be ____ when u get SS
65
when ppl born in 1943 bcm ______, they get medicare
65+
In order to get medicare, you have to be qualified for the SS retirement benefit/ ___-___ years old, have a disability, or be on hemodialysis (ESRD)
65-66
If you were born in 1943-54, you would be _____ years old when u can receive medicare
66
how old r ppl now before medicare?
67
You can buy C based on ___ and ___ QUALIFICATIONS
A and B
What is Medicare
A federal health insurance program for older adults and those with permanent disabilities
MEDICAID IS...
A joint federal and state medical assistance program for the poor
___ does NOT have a medigap policy
CALIFORNIA
a ___ ___ Refers client to community resources regarding client's needs; gate keeper
CASE MANAGER
The amount you may be required to pay for services after you pay any plan deductibles. A percentage (like 20%) of the Medicare-approved amount. Payment after you pay the deductible for Part A and/or Part B
Co-insurance
In some Medicare health and prescription drug plans, the amount you pay for each medical service, like a doctor's visit or prescription
Co-payment
who Monitors patient's hospital progress, Recommends appropriate levels of discharge and Helps patient plan for discharge?
DISCHARGE PLANNER
The amount you must pay for health care or prescriptions before the original Medicare Plan, your prescription drug plan, or other insurance plan begins to pay.
Deductible
What are some IMPLICATIONS for MEDICARE D?
Eligible citizens must decide and choose between dozens of private insurance plans according to a specific list of drugs, premiums, co-payment rates, and deductibles. The donut hole: People are forced to pay premiums!!!!!!!!!! 4.6 million (10%) do not have drug coverage. In 2007, an estimated 3.4 million Part D enrollees (14% of all enrollees) reached the coverage gap which is not covered People become frustrated, especially those who have cognitive, hearing, and visual difficulties. The legislation was written largely by and for the pharmaceutical and insurance industries. Drug prices rose faster than the general rate of inflation.
in 2010 010: Health Care Reform Bill: The Affordable Care Act was passed by Obama which said what?
Expand care coverage to all Americans
MANDATORY SERVICES OF MEDICAID?
In-patient and out-patient hospital care Physician and other medical provider services Skilled nursing facility care Laboratory and X-ray services
WHO PAYS FOR 1/2 OF CARE DELIVERED IN SNFs???
MEDICAID!!!!!!
____ _ incudes Home health care, PT, OT, Speech Tx, medical social services, durable medical equipment, medical supplies and Hospice care
MEDICARE A
what covers XRAYS?
MEDICARE B
2 way is MEDICARE ADVANTAGE PLAN= ____
MEDICARE C
what covers out pt prescription drugs?
MEDICARE D
who Influences health outcomes, Reduces care redundancy, Applies care in a cost-effective manner?
MULTIDISCIPILINARY TEAM
Under the new Health Care Reform Bill, nearly everyone under age 65 with income below a national "floor" (133% of poverty level) will be eligible for ____
Medicaid
most poor people have
Medicaid/Medical
most old people have ____
Medicare
MEDICARE C is ____ ___ __ or "Medicare + Choice", a plan offered by a ___ ___ that contracts with Medicare to provide client with all Medicare Part A and B benefits
Medicare Advantage Plans, private company,
Medicare HMO and PPO are plans under ____ _
Medicare C
MEDIGAP POLICY
Medicare supplemental insurance Fill the gap that Medicare plans do not pay, such as copayments, coinsurance, and deductibles. Make ones health care costs more predictable Sold by private insurance with various options
is dental covered?
NO
is hearing covered?
NO
mam and PT and preventative care covered?
NO, not preventative care
the OOA (____ ___ ___) was created on ____ ____ ____ which Takes responsibility for well-being of older adult citizens, Expanded opportunities to enrich their lives, was administered by State and Area Agencies on Aging and felt that WE NEED TO KEEP OLDER PPL'S QUALITY OF LIFE and PROTECT THEIR HARMFUL ISSUES FROM SOCIETY
Older Americans Act, July 14 1965
OPTIONAL SERVICES OF MEDICAID?
Prescription drugs (No more covered) Dental and vision care Hospice care In-patient psychiatric care Rehabilitation and therapy services
_____ and ____ go together
SS and medicare
MEDICARE B is ____ ____ ___, funded by ____ ___ + ____ ____(premium-how much u pay-96, and additional for high income, deductible-162 and coinsurance is 20%), requires a _____ ____, and co-payment for ___ ___ ___, is also for the _____ who cannot pay the monthly payment and the fed programs are operated to support part or full payment (limited income of <4000/person or 6000/couple)
Supplementary Medical Insurance, general revenue + beneficiary premiums, personal decision, out-patient services, poor
a person qualifies for Medicare benefits increase every year...t or f
TRUE
WHAT IS A PREMIUM?
The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage.
WHO IS ELIGIBLE FOR MEDICAID?
Those who receive SSI. Medicare beneficiaries with income less than 133% of Federal Poverty Level. Those who are beneficiaries of disabilities for 2 yrs before 65 years old. Illegal immigrants are not eligible by Health Care Reform
are labs and xrays covered by B?
YES
they pay....$1,132 for the first 60 days of hospitalization then u pay $283 per day for days 61-90 of a hospital stay--> $289/day in 2012 $566 per day for days 91-150 of a hospital stay--> $578/day in 2012 ___ ____ for each day beyond 150 days
all costs
WHO CAN HAVE MEDICARE D? AND....... ___ __ ____
anyone who as A and B OR C, joining is voluntary
FOR MEDICARE A ENROLLMENT, Enrolled a few months _____ age 65. Recipients receive Medicare Card two months before age 65. If the person is not retired yet and still working, the person has to report to the ___ _____ and enroll for ____ ______. After age 65, the ____ ____ ____ is the primary payer
before, SS Office, medicare insurance, group health plan
the Coverage Gap (donut hole):
begins once you reach your Medicare Part D plan's initial coverage limit ($2,930 in 2012) and ends when you spend a total of $4,700 in 2012 by the AFFORDABLE CARE ACT
MEDICARE C is FUNDED THROUGH ____ ___ ___ ___ ___
beneficiary premiums and general revenues
the number of workers per beneficiary making payroll contributions is _____ because there are less old people now working because the baby boomers are in the 65-70 yo range and are no longer working
decreasing
What are NOT covered by A and B? (6)
dental care and dentures, hearing aid and hearing exam, routine eye exam and most glasses, acupuncture, long-term care, prescription drugs
_____ and _____ only total 25% of the enrollees but about ____-% of the total expenditures is on them!!!!
elderly, disabled, 75%
MEDICARE D is funded by ___ ___, like C, ___ ___ and ___ ____
general revenue, state payments, beneficiary premiums
MEDICARE A is a ____ ____ ___ funded by a dedicated Medicare tax (2.9 % of earnings) of current workers and by the co-payments of the beneficiaries. THere is____ ____. If not qualified, $248~451/mo.... if immigrants want this benefit, have to pay this ________!!!!!!
hospital insurance program, NO PREMIUM, monthly
with the avg full benefit being 1178, you will be seeing and ____ in 35$ more/mo in 2012
increase
Medi-Cal is the nation's _____ Medicaid program in the number of enrollees and the second largest budget spent in 2008-2009 Medi-Cal spends _____ dollars per enrollee and per resident Medi-Cal covers a_______ proportion of children and adults enrollees relative to other states. CA spends about 13% of its own funds on Medi-Cal vs an average of 16% nationally. CA spends slightly _____ on ___ ____ ___ services and more on acute-care services compared with the national average. "Dual eligibles" are 18% of Medi-Cal beneficiaries, but represent 46% of Medi-Cal expenditures overall in 2005. With budget shortfalls, the state reduced spending in Medi-Cal by reducing provider payment rates, reducing benefits, and restricting eligibility.
largest, less, higher, LESS, long term care,
SSI is for _____ or ____and can get at ____yo but not 100%
low income, disabled, 62
One in six Americans under age 65 is insured through _____
medicaid (17%)!
FOR MEDICARE A SHORT TERM REHAB CARE: SNF you pay ____ for the first 20 days and then 141.50/day for 21-100 days
nothing
1 way is A +B (___ ___ __) + D + Medigap
original medicare plan
MEDICARE D covers ___ ___ ___ ___ which was not covered before and some ppl with HTN or 15 meds need this
out patient prescription drugs
in the donut hole, people are FORCED to ____ ____
pay premiums
WHAT DOES MEDICARE B COVER? _____ visits, certain ___ ____ ____, durable ___ ___, med services such as ____ ___ ____ ____, ___ __ such as mammography, flu vacc, DM lab, bone mass msrmnts, chol, glaucoma test, education, connection with the ____, ___% have this and ____% in cali
physician, home health services, med equipment, lab, x=ray, ambulance, PT, preventive services, government (private company), 24, 34
most ppl get their Medicare health care coverage in one of 2 ways and it depend on your ___, ___ and the ____ you use
plan, coverage, services
MEDICARE D is considered ____ ___ ____
prescription drug plan
Annual ____ is required to maintain eligibility.
recertification (MEDICAID)
medicare spending is on the _____
rise and trust funds are sure to be exhausted soon
for SS retirement benefits if you have ___ for more than ___ years and paid ____, your gross income would be > 1120/mo
worked, 10, taxes
is ambulance covered?
yes, by B