Governmental Health Insurance Programs

Medicare Part A (aka Hospital Insurance or HI)

Provides hospital insurance automatically @ age 65 (if FICA qualified) @ no fee but may have deductible & co-pay.

Reimbursement of Medicaid

Varies state by state and by provider, much lower than private insurance

Block Funding

sum of money granted by the national government to a state government with only general provisions as to the way it is to be spent.

Medicare Part C (Medicare Advantage)

•Replaces and covers expenses found in Part A and B •Medicare private fee-for-service plans (PFFS) •Medicare managed care plans (HMOs and PPOs) •Medicare specialty plans

Entitlement

include medicaid, medicare, social security, unemployment, and welfare programs. Rights granted to citizens and certain non-citizens by federal law.

Eligibility for Medicaid

must meet eligibility requirements including categorical, income level, resources, residency, and immigration status

Medicare

A federal program of health insurance for persons 65 years of age and older and the disabled

Medicare Part B

The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies.

Medicare—Part D Prescription Drug Coverage

a United States federal-government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries.

State Children's Health Insurance Program (SCHIP)

a public health insurance program, jointly funded by the federal and state governments, that provides health insurance coverage for children whose families meet income eligibility standards

Medicaid

joint federal-state program that is administered by the states under federal guidance, states must provide coverage to individuals who meet categorical and financial eligibility criteria. Typically covers low-income, pregnant women, children, and adults with dependent children, the disabled, and the elderly.

Benefits of Medicaid

physician services, lab/x-ray services, inpatient hospital services, outpatient hospital service, home health care services, transportation to medical care. Optional Benefits: prescription drugs, clinic services, dental, hospice

Future of Medicare

post financial challenges due to aging population