funding Flashcards
part A
Funded by 2.9% payroll tax
(1.45% from employees, 1.45% from employers)*
Deposited into “Medicare trust fund
ACA increased this contribution by 0.9
for individuals earning >$200,000
and couples earning over $250,000
part B
general revenues and primimums paid by enrolees
Federal government pays 75% (out of general fund)
Beneficiaries pay 25%
part c
JUST DELIVERS BENEFITS FORM THE OTHERS
PART d
general revenues and beneficiaries premiums
and from states for duel eligibles
problems with medicare
donut hole
and no cap on out of pocket fees
what does supplemental coverag look like for most people on medicare
medicaid-poor
private companies
nothing
employer
medicare beneficiaries are spending
larger share of income on health expenses
trends in premiums
they are getting bigger along with the donut hole
but social security checks are rising more slowly
medicare is _ of federal budget
13% of federal budget
with SS a 1/3 of federal spending
mostly due to increasing healthcare costs
what is the issues with spending for medicare
a small subset of beneficiaries account for the majority of spending
44,000 compared to 3,000
need to pull down costs for high spenders
better coordinated care
medicare covers
65 or older,
certain younger people with disabilities, and
people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
part A covers
inpatient hospital stays,
care in a skilled nursing facility,
hospice care,
some home health care.
premium for part A
Most people don’t pay a monthly premium for Medicare Part A
if you have to buy it because you are not eligible it is 405 $ a month
Part B covers
certain provider services,
outpatient care,
medical supplies,
preventive services.
when do you get your medicare part A card
certain provider services,
outpatient care,
medical supplies,
preventive services.
signing up for medicare part B
you must enroll and pay a premium
In most cases, if you don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late enrollment penalty for as long as you have Part B, and could have a gap in your health coverage.
cost of part B
Most pay the standard Part B premium of $134 each month;
)
The Part B deductible is $183 per year
Co-insurance (after meeting deductible) is 20% of costs
Up to additional 15% for “non participating” physicians
All Rx costs
Dental Care
Eye glasses, hearing aids, foot care, etc.
Part A hospital deductible per hospital sta
($1316)
medicare part D is offered by
offered by insurance companies and other private companies approved by Medicare.
trend of elderly
9% in 1965
13 % were over 65 in 2010
in 2030 it will be 20%
DRGs
Medicare pays hospitals per beneficiary discharge, using the
Inpatient Prospective Payment System. The base rate for each discharge corresponds to one of over 700
different categories of diagnoses—called Diagnosis Related Groups (DRGs)—
f hospital provides care for less than average cost, it can keep the difference
If cost of care is more, the hospital absorbs the difference
medicare part C
Paid plans 95% of what would have paid for the beneficiary in traditional, FFS Medicare
HMOs were required to offer ALL that was offered under Medicare; could offer more
Part C Medicare Advantage Plans may target healthier, younger Medicare beneficiaries (“favorably selecting,” or “cherry picking”)
why does medicare face adverse selection with the introduction to part C
This leaves Traditional FFS Medicare facing “adverse selection,” with sicker, more costly patients
what% of medicaid does the federal govt pay for
50-76%
