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