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%
FMAP
federal map assistance percentage
how did medicaid change with the expansio
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.
how would block grants work
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.
the majority of medicaid spending is for
acute care
medicaid coverage
in 2/3 below the poverty level
what is the coverage for children
49 states cover children with incomes up to at least 200% of the federal poverty level
how many people are on medicaid and how many on medicare
19% on medicaid
14% on medicare
how does chip differ from medicaid
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
Section 1115 Waivers
provide flexibility to design and improve state programs in order to
- the first prepaid hospital insurance plan in the United States and predecessor of Blue Cross.
The Baylor Plan
