funding

Question 1

part A

Answer 1

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

Question 2

part B

Answer 2

general revenues and primimums paid by enrolees

Federal government pays 75% (out of general fund)

Beneficiaries pay 25%

Question 3

part c

Answer 3

JUST DELIVERS BENEFITS FORM THE OTHERS

Question 4

PART d

Answer 4

general revenues and beneficiaries premiums

and from states for duel eligibles

Question 5

problems with medicare

Answer 5

donut hole

and no cap on out of pocket fees

Question 6

what does supplemental coverag look like for most people on medicare

Answer 6

medicaid-poor
private companies
nothing
employer

Question 7

medicare beneficiaries are spending

Answer 7

larger share of income on health expenses

Question 8

trends in premiums

Answer 8

they are getting bigger along with the donut hole

but social security checks are rising more slowly

Question 9

medicare is _ of federal budget

Answer 9

13% of federal budget

with SS a 1/3 of federal spending

mostly due to increasing healthcare costs

Question 10

what is the issues with spending for medicare

Answer 10

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

Question 11

medicare covers

Answer 11

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).

Question 12

part A covers

Answer 12

inpatient hospital stays,
care in a skilled nursing facility,
hospice care,
some home health care.

Question 13

premium for part A

Answer 13

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

Question 14

Part B covers

Answer 14

certain provider services,
outpatient care,
medical supplies,
preventive services.

Question 15

when do you get your medicare part A card

Answer 15

certain provider services,
outpatient care,
medical supplies,
preventive services.

Question 16

signing up for medicare part B

Answer 16

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.

Question 17

cost of part B

Answer 17

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.

Question 18

Part A hospital deductible per hospital sta

Answer 18

($1316)

Question 19

medicare part D is offered by

Answer 19

offered by insurance companies and other private companies approved by Medicare.

Question 20

trend of elderly

Answer 20

9% in 1965

13 % were over 65 in 2010

in 2030 it will be 20%

Question 21

DRGs

Answer 21

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

Question 22

medicare part C

Answer 22

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”)

Question 23

why does medicare face adverse selection with the introduction to part C

Answer 23

This leaves Traditional FFS Medicare facing “adverse selection,” with sicker, more costly patients

Question 24

what% of medicaid does the federal govt pay for

Answer 24

50-76%

Question 25

FMAP

Answer 25

federal map assistance percentage

Question 26

how did medicaid change with the expansio

Answer 26

When the law was passed in March 2010, states were required to expand Medicaid to all adults with income up to 138% of FPL by 2014.

then states sued the goverment and now it is optional

For states that expanded Medicaid, the federal government paid 100 percent of the cost for newly eligible enrollees for the first few years, and the federal share is now ratcheting down to an eventual 90 percent.

Question 27

how would block grants work

Answer 27

to a program of block grants, in which the government allots to each state a fixed amount of money each year and frees states from many of the program’s rules about what health services must be covered.
Block grant proponents say that they would give states more flexibility to run their programs as they see fit; detractors say they are a smokescreen to curb federal spending and ultimately would hurt poor people.

Question 28

the majority of medicaid spending is for

Answer 28

acute care

Question 29

medicaid coverage

Answer 29

in 2/3 below the poverty level

Question 30

what is the coverage for children

Answer 30

49 states cover children with incomes up to at least 200% of the federal poverty level

Question 31

how many people are on medicaid and how many on medicare

Answer 31

19% on medicaid

14% on medicare

Question 32

how does chip differ from medicaid

Answer 32

Not an entitlement to individuals: states can establish waiting periods, waiting lists
Income eligibility is higher; upper limit ranges from 175% of federal poverty level (FPL) (North Dakota) to 405% FPL (New York)
Modeled on private insurance with options for:
Monthly premiums
Benefits may be pegged to commercial benchmark
Branding

Question 33

Section 1115 Waivers

Answer 33

provide flexibility to design and improve state programs in order to

Question 34

• the first prepaid hospital insurance plan in the United States and predecessor of Blue Cross.

Answer 34

The Baylor Plan