Medicare

Who is eligible for Medicare?

All Americans 65 years and older, but they must have worked and contributed at least 10 years to FICA or be married to someone who has.

FICA

Federal Insurance Corporation of America; part goes to SS and part goes to Medicare. A person must have contributed to this for at least 10 years or be married to someone who has in order to be eligible for Medicare.

Medicare D

medications - numerous prescription drug plans; passed in 2003, effective 2006; must meet eligibility criteria

How is Part B funded?

monthly payments as well as govt subsidy

How is Part A funded?

mostly through FICA payroll taxes

The cost of Medicare

now based on income after ACA (2014); before all paid the same

Medicare D

outpatient drug coverage; voluntary and subsidized; newly added in 2003 and effective in 2006

Who is eligible for Part B?

people who have Part A can select B (will pay a fee)

What does Part B cover?

physician; outpatient; preventive; home care; lab tests; diagnostic x-rays; etc.

What does Medicare B cover?

physician; preventative; outpatient; homecare

Medicare Provider Number

providers/pharmacists/dieticians (in some states) - can bill for Medicare Part B services using this number pharmacists - MTM in some states where considered health care providers

Medicare card

red, white, and blue card that tells which part patient could be entitled to and the effective date

ACA changes to payment

If you make more, you pay more

How are Part B and D funded?

both have monthly premiums beneficiaries pay only 25% of B and 13% of D (govt subsidizes the rest)

Why are many seniors defaulting to Part C?

simplicity - covers most of A, B, D ACA is complicated almost 25% of managed care population in C

Medicare B

supplemental medical insurance

What percentage of US health care spending is represented by Medicare?

15% of federal budget and 21% of all health care spending in US

When was Medicare passed?

1965

General revenue amounts to what percentage of medicare revenue?

40% of all in 2012 federal govt; tax dollars

Part A Entitlement

Anyone who is an American citizen who has contributed to FICA for 10 years is entitled (no paying extra; enroll at age 65 and automatically have it)

Who is Medicare administered by?

Centers for Medicare and Medicaid Services (CMS) in Department of Health and Human Services (HHS)

Who is not eligible for Part A?

Non-citizens; those who have not contributed to FICA; some city/govt employees who have special govt. insurance

Decide how you want to get your coverage.

Original Medicare vs Medicare Advantage Plan (HMO or PPO)

What does the patient pay for Part B?

Person must pay a monthly fee depending on income. After ACA, it changed from being same for everyone. e.g. $85.000 or less/year ---> $104.09/month

Medicare is a federal program

Therefore it has the same benefits and costs in each state

If you have Medicare A/B and D and still need additional supplemental coverage

You will need Medigap (Medicare Supplement Insurance)

If you make over $200.000 single / $250.000 joint

additional 0.9% (added to 2.9%) of income above

Medicare supplemental policies

different parts of the countries have different policies based on zipcode

Medicare supplemental to A and B

helpful for deductibles, copays aka Medigap

Medicare A

hospital insurance

What does Medicare A cover?

hospital, skilled nursing care (e.g. rehab); home care; hospice (not long-term nursing homes)

Medicare D Plans vary

in drugs covered, monthly premiums, deductibles

Medicare Part C

managed version of Medicare covering A, B, D

Medicare C in Massachusetts

varying coverage, copays, fees

If you need additional drug coverage for the Medicare Advantage plan,

you can get Part D but you cannot get Medigap

If you choose original Medicare, you will have

Part A (hospital) and Part B (medical)

If you choose Medicare Advantage Plan, you will have

Part A, B, and usually D

If you make less than $200.000 single / $250,000 joint

2.9% - half is paid by employer and half is paid by employee

How many were covered by Medicare in 2013?

54 million (elderly and disabled)

A person who has Medicare C would not have

Medicare A or B, since C would cover these

Medicare Part C aka

Medicare Advantage / Private Insurance / Managed Care Option (Medicare Part C)

If you choose original Medicare and need additional drug coverage, you will need to sign up (and pay for)

Medicare D

What was added to Medicare in 1972?

End Stage Renal Disease Program and then for those with permanent disabilities (2 year wait); expanded to Lou Gehrig's disease

Medicare C is a managed care option

covers equivalents of Parts A, B, and D (most); physicians from a managed care network