Medicare & Medicaid Flashcards
What is significant about July 30, 1965?
When the medicare & medicaid programs were signed into law.
Most significant legislative change to medicare?
Medicare Modernization Act (MMA)
When was MMA signed into law? By whom?
December 8, 2003
Former President from Texas, George W. Bush.
What is the MMA?
Historic legislation adds an outpatient presecription drug benefit to Medicare.
What is Medicare?
A health insurance program for people age 65 or older,
people under the age of 65 with certain disabilities, & for people of all ages with End-Stage Renal Disease.
Medicare has 3 coverages?
Part A Hospital Insurance
Part B Medical Insurance
Prescription Drug Coverage
Part A Hospital Insurance
Helps cover inpatient care in hospitals, including critical access hospitals, & skilled nursing facilities. It also helps cover hospice care & some home health care. Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.
Part B Medical Insurance
Helps cover doctors services & outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical & occupational therapists, & some home health care. Helps pay for these covered services & supplies when they are medically necessary.
Prescription Drug Coverage
Most people pay a monthly premium for this coverage. Everyone with Medicare can get this coverage that may help lower prescription drug costs & help protect against higher costs in the future. This is an insurance. Private companies provide this coverage. If the beneficiary doesn’t enroll when first eligible they may pay a penalty if they choose to join later.
Medicaid Program
Medicaid & CHIP provide health coverage to nearly 60 million Americans, including children, pregnant women, parents, senior, & individuals with disabilities.
In order to participate in Medicaid…
The federal law requires states to cover certain population groups (mandatory eligibility groups) & gives them the flexibility to cover other population groups (optional eligibility groups).
States in Medicaid
States set individual eligibility criteria within federal minimum standards. States can apply to CMS for a waiver of federal law to expand health coverage beyond these groups.
Federal Minimums
Many states have expanded coverage, particularly for children, above the federal minimum.
Eligibility Groups
Many eligibility groups, income is calculated in relation to a percentage of the Federal Poverty Level (FPL).
FPL (Federal Poverty Level) Example
100% of the FPL for a family of four is &23,550 in 2013. The FPL is updated annually. For other groups, income standards are based on income or other non-financial criteria standards for other programs, such as Supplemental Security Income (SSI) program.
