Medicare

Who is covered under Medicare?*

The program covers all those who are eligible regardless of their health status, medical conditions, or incomes.

Center for Medicare and Medicaid Service

Agency responsible for administering Medicare and Medicaid (macroorganization)

What is Medicare?

Federal program that provides health insurance coverage to people ages 65 and older and younger people with permanent disabilities. The 4 part program covers all those who are eligible regardless of their health status, medical conditions, or incomes.

How is Medicare financed?*

Funding comes primarily from general revenues (41%) and payroll taxes (38%), and by premiums paid by beneficiaries (13%)

Hospital Insurance Trust Fund

risk pool financing for part A

Supplementary Medical Insurance (SMI)

risk pool financing for part B combined with general revenues

How do beneficiaries pay for benefits?

via varying premiums, deductibles, and coinsurance amounts that can change annually to reflect changes in program costs. = relatively high cost-sharing requirements for covered benefits.

Types of taxes*

Progressive, Regressive, Flat

What does Medicare Part B cover?

covers outpatient services such as outpatient hospital care, physician visits, and preventive services; ambulance services, clinical laboratory services, durable medical equipment (such as wheelchairs and oxygen), kidney supplies and services, outpatient mental health care, and diagnostic tests

Public Health Insurance*

**coverage provided by a government and funded with public money.

Private Health Insurance*

**coverage provided by a health plan provided through an employer or union or purchased by an individual from a private company.

Who is eligible for Medicare?*

1. People age 65 and older. 2. People under age 65 after 24 months of receiving Social Security Disability Insurance (SSDI) payments, or if they have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease)

When was Medicare established?

1965

What is covered (very generally) under Medicare?*

Basic health services, including hospital stays, physician visits, and prescription drugs.

State Funded Program

Benefits and access will vary from state to state; some states are more generous than others

Is Medicare an entitlement program?*

Yes and so is Medicaid. CHIP is not.

Means tested program

You must meet certain income requirements in order to participate based around the federal poverty line (i.e. CHIP, Medicaid, SNAP, WIC)

What's an entitlement program?*

a program where if you meet the criteria and choose to enroll you cannot be turned away or rejected from the program; means that there is little control over the spending on the program since they cant turn people away

Regressive Tax*

a tax system in which the tax rate decreases as the amount subject to taxation (taxable amount) increases = people who make less pay more (percent of income)

Progressive Tax*

a tax system in which the tax rate increases as the amount subject to taxation (taxable amount) increases people who make more pay more (percent of income)

What does Medicare Part C cover?

covers all Medicare-covered benefits covered under other parts, but as private health plans can vary the benefit design as long as the core benefit package (excluding the value of supplemental benefits) is actuarially equivalent to traditional Medicare. May also include extra benefits, such as dental services, eyeglasses, or hearing exams; AKA "Medicare Advantage"

What does Medicare Part D cover?

covers an outpatient prescription drug benefit through private plans. Plans are required to provide a "standard" benefit or one that is actuarially equivalent, and may offer more generous benefits.

Discretionary Spending

eligible people are not entitled to the program and can be turned away

Flat Tax*

tax system with a constant marginal rate (proportional) = everyone pays the same (or same proportion) regardless of income

earmarked taxes

taxes set aside for a particular purpose (ie Medicare)

How does Medicare pay providers?

traditionally on a fee for-service basis; in the future payments will be linked to performance

Fee for Service Medicare

Part A and B

Federal Poverty Line

A numeric amount that if a person makes below it you are considered to be in poverty based on household size and income; Originally calculated based on the cost of food

What are some gaps in Medicare coverage?

Long-term care services, vision services, dental care, and hearing aids.

Medicare Part D

Managed by private insurers

Medicare Part C

Managed by private insurers; Medicare Advantage

Medicare Part B

Managed by the government

Medicare Part A

Managed by the government (Center for Medicare and Medicaid Service)

How many people are covered by Medicare?

55 million people, including 46 million ages 65 and older and 9 million younger people with permanent disabilities

Federally Funded Program

Equal benefits and equal access to all eligible and enrolled participants throughout the country - everyone gets the same thing regardless of where they live

Doughnut Hole

Portion of Part D where there is less coverage (45% for brand names, 50% for generics paid by participant)

Medicare Advantage

Private health plans that receive payments from Medicare to provide Medicare-covered benefits to enrollees. 3 in 10 beneficiaries are enrolled in these plans. AKA Medicare Part C

What does Medicare Part A cover?

covers inpatient care provided in hospitals and short-term stays in skilled nursing facilities, hospice care, post-acute home health care, and pints of blood received at a hospital or skilled nursing facility