Day 3

What are the elements of the Medicare Part D plan?

Monthly premium Deductible Co-payments Co-insurance

What happens if an eligible patient doesn't enroll?

1. They may pay a penalty. 2. The penalty lasts until the patient dies

Who is eligible for Medicare part D?

Anyone eligible for Medicare Voluntary program: must choose to enroll and Medicare recipients MUST pay a premium to enroll in the plan If Medicare-eligible person delays enrolling in a Part D plan, they may a penalty if they try to enroll later

What are the benefits of Part A Medicare?

Automatic enrollment for anyone eligible no complex enrollment process Ex. Part A covers hospitalization

What are the affordable care act benefits to the individuals?

Children can remain on parents plan until they turn 26 (but doesn't require parents to do this) Insurers cant deny coverage to individuals with pre-existing medical conditions.

Medicaid conclusions?

Concerns about rising costs of the Medicaid program The Medicaid programs helps low-income children: it is challenging for some politicians to vote to cut spending for the program State governments can control costs by reducing reimbursement rates to health care providers.

Medicare Conclusion

Concerns about the rising costs of Medicare program - will it go bankrupt? It is challenging for some politicians to vote to cut spending for Medicare bc they won't risk angering effective lobbying groups like AARP

What is the affordable Care Act (ACA)

Created to help people not covered by Medicaid or Medicare or employer to have access to medical care

What are the Medicare Pard D prescription drug benefit?

Federal Gov program to help Medicare beneficiaries pay for outpatient prescription drugs It is an insurance plan - it protects individuals from high prescription drug costs

Medicare: Government responsibilites?

Federal Government program only not state Fed Gov does: >Administer the program >Determines eligibility through the Social Security Administration >Sets the policies for the program

How is Medicaid financed?

Federal and state governments finance program >states must budget tax dollars for the program >Each state entitled to payments for the feds. Nursing home patients expected to spend most of their income before Medicaid starts paying

What is Medicare?

Federal government helps the elderly & individuals with certain disabilities to have access to medical care

For Part A how is Medicare financed?

Funded by a Federal government trust fund Employees and employers have payroll taxes General federal tax revenues Beneficiaries' premiums, deductibles and co-payments

Part B Medicare financing?

General federal tax revenues Beneficiaries' premiums, deductibles and co-payments Concerns that Medicare will go bankrupt

Public sectors

Government programs like Medicaid and Medicare are intended to provide a "safety net" to cover patients the private sector doesn't cover

Part D - who is eligible?

If employed, check to see if your employer's drug coverage is "creditable" is it comparable to Medicare Part D plan?

Medicaid: Government responsibilities: Federal government?

Joint Federal & state program Fed gov does: Sets eligibility standards and defines the minimum Medicaid services that must be provided by state governments >Pays majority of the expenses

Who is eligible for Medicaid?

Means tested: eligibility for the program tied to person's income federal government defines poverty level Can be difficult for individuals to enroll in the program >A relatively large amount of paperwork is required.

What if patient keeps working after 65 or is covered by spouse's plan?

Obtain written confirmation that this plan is considered by Medicare to be equivalent to a Part D plan. If no confirmation, you will likely have to pay a penalty if you don't enroll in a Part D plan.

For Part A who is eliglble?

Part A is free for most people Provides hospital coverage and other benefits If you're already receiving social security, you will automatically enrolled in Part A when you turn 65

Medicare who is eligle?

Persons > 65 years old Disalbed individuals under 65 who meet certain criteria Medicare is NOT means tested for eligibility. Millionaires & billionaires can use program

What is an example of a Medicaid optional service?

Prescription drugs

What are some major themes of the affordable care act?

Standardize health insurance plan benefits - required health insurance companies to offer plans with minimum benefits such as maternity care, mental health services, preventative care, cancer screenings In December 2017, this penalty was eliminated effective 2019, there is no individual financial penalty for not purchasing health insurance.

What are the affordable care act benefits to the providers?

Standardizes insurance company paperwork Encourages policies that reward providers and organizations for providing quality medical care

What is Medicaid?

State governments help people living in poverty to have access to medical care

What should a patient consider when selecting a Part D plan?

The costs of the premium, deductible, coinsurance & drug copayments Does the plan have a limited formulary? Convenience- is the pharmacy close or does it have a mail order option

What are the benefits of Part C Medicare?

Voluntary enrollment for anyone eligible Considered the "Managed Care" option Is required to provide a comprehensive range of services >If you enroll in Part C, you are considered to have services equivalent to services provided in Part A, B and D.

Part B Medicare Benefits?

Voluntary enrollment for anyone eligible - most people enroll ex. Part B covers Physician visits Retail pharmacies may provide some services as an approved supplier

Medicaid: Government responsibilities: State Government?

administers the program Complies with federal government requirements Determines if it wants to offer more than minimum Medicaid services required by the federal government

What is Medicare Part D?

federal government helps the elderly pay for the out-patient prescription drugs

For Part B who is eligible?

has a monthly premium The premium is higher for people with higher incomes Pays for doctors bills, lab tests, outpatient care

What do we mean by private sector?

healthcare is provided by an employer Most industrialized countries in the world, the US relies on the private sector to provide healthcare The US private sector historically controls and efforts to ration healthcare