EXTRA CREDIT -- CH 18 Medicare and Medicaid Flashcards
true or false
medicare has had tremendous growth since its inception
true
as mentioned, there has been rapid growth in medicare beneficiaries since its expansion.
what does this lead to?
rapid growth in medicare program SPENDING
what were the 2 largest individual components of total medicare expenditures in the 1960s?
what changed in 2010? what was the reason for this
inpatient hospital services and physician services in the 1960s
in 2010, it was inpatient hospital services and MANAGED CARE SERVICES – these were not even existent until the 90s
what is another word for medicare supplement insurance
MEDIGAP
is medigap (medicare supplemental insurance) the same as medicare part C?
NO
medicare part C INCLUDES part A and B as well as additional benefits
MEDIGAP is a SUPPLEMENT to the original parts A and B
true or false
medicare does NOT pay for all of their beneficiaries health care bills.
it actually pays less than half of the average person’s expenses
true
as mentioned, the average medicare beneficiary has substantial cost-sharing requirements in the form of deductibles, premiums, coinsurance, copayments, etc
what is available to help these beneficiaries meet these cost sharing requirements?
(4 potential things)
-some patients may have additional retiree health insurance through a former employer/union
-might be poor enough to qualify for medicaid
-enroll in a medicare advantage plan that covers more services than traditional medicare (part C)
-can purchase additional private insurance known as MEDICARE SUPPLEMENT INSURANCE (medigap)
______- insurance is designed to pay for many of the charges for medicare-covered services for which the benficiary is responsible
medicare supplement insurance (AKA medigap)
explain how medigap policies are classified
in letters – A-N
which medigap policy is REQUIRED for each state to allow the sale of it in accordance with federal law? also, all Medigap insurers must offer this plan.
it is the most basic Medigap plan
Plan A
how many “basic benefits” are in Plan A of Medigap? name them
5:
covers:
1. Part A coinsurance hospital costs up to an additional 365 days after medicare benefits have been used up
- Part B coinsurance or co-payment
- Part A hospice care coinsurance or co-payment
- 3-pint blood deductible
- Preventative Part B coinsurance
explain other medigap plans (besides A)
other plans offer additional benefits on top of Plan A.
this could include covering Part A hospital deductible and part B deductible
which 2 medigap plans include an annual LIMIT on beneficiaries’ out of pocket spending?
K and L
once the limit is reached, parts K and L pay 100% of covered services for the rest of the year
in addition to initiating the medicare program, the 1965 amendments to the Social Security Act established what other program?
it is called Title _____ of the social security act
MEDICAID
title 19 – “Grants to the states for medical assistance programs
what is the largest source of funding for the provision of health-related services to the United States’ poorest people?
MEDICAID
Medicare was originally a ____ on the medicare bill in 1965
RIDER
after _______’s election, movement towards a universal health plan stalled
Richard Nixon
at the time, many people viewed the legislation that created medicare and medicaid as a ____ measure.
why?
STOPPGAP
people assumed a democrat like Lyndon Johnson or Hubert Humphrey would be elected in 1968 and universal health plan would be a reality soon
3 broad groups of people may be covered by a state’s Medicaid program:
-the mandated categorically needy
-the optimally categorically needy
-the medically needy
explain eligibility for medicaid.
does it vary state to state?
states establish their own criteria within federal guidelines – eligibility varies from state to state
_______ is a joint state-federal program
MEDICAID
Name the 3 groups who are classified as “medically categorically needy”
-low income families with children
-children under 6 and pregnant women whose family income is below 138% of Federal Poverty Line
-Children under age 19 in families whose income is below the FPL