Medicare/Medicaid Flashcards
eligibility criteria
factors that determine whether people can receive benefits from specific programs
age-based entitlement programs
programs that all adults are automatically entitled to receive benefits based on their age, not on their financial or health needs. Social Security and Medicare are examples.
universal and categorical benefits
age-based programs available as a social right to all persons belonging to a designated category, e.g., those over a certain age
needs-based programs
decide eligibility by financial need
selective benefits
determined on a case-by-case basis
contributary plans
older adults are entitled to these benefits based on their mandatory contributions into the system as a paid worker throughout their lives
discretionary funding (TANF)
Congress has to approve its funding annually and the amount varies from year to year
ex: TANF for low-income children and parents
graying of the federal budget
wide array of federal budget going to programs etc for the older population
retirement savings plan vs. safety net
social security used to be a safety net of financial support to help them survive since they didn’t think to save for retirement or didn’t think they would live that long or growing debt
social adequacy
shared societal obligation to provide a basic standard of living for all who are eligible, regardless of the size of their payroll contributions
individual equity
people receive benefits such as Social Security based on their earned right –payroll deductions
Social Security benefits
- frees middle generation from financial support to older relatives
- ensures compensatory income, regardless of age, to those who experience sudden income loss
- ensures basic protection for the neediest members of society regardless of age
long term care
long-term care
includes at home care, institutional care (nursing homes)
your needs can change over time high/low
acute care
active but short-term treatment for episode of injury or illness, urgent medical condition, or recovery from surgery
can just include a doctor’s visit
Medicare
social insurance system based on age available to all adults age 65+
federal funding
beneficiaries earn access by virtue of paying payroll taxes throughout the years of employment. it is intended to provide financial protection against the costs of acute or short-term care by hospitals and physicians
- Medicare reform: Medicare Part D, the Medicare Modernization, Improvement and Prescription and Drug Act
Medicare limitations
covers acute or short-term care but does not reimburse for long-term services and supports for older persons with chronic illness
- only covers about 47% of older adults’ health care expenses
Medicare-funded home healthcare
only 4% of healthcare expenditures covered are for home healthcare – must have a medical based need (cannot just be assistance with ADLs)
only for a short amount of time (injury etc)
“rehab center”
Medicaid
federal and state means-tested program
for poor and needy
don’t need to pay into it
– biggest payer of long term care (nursing home/”rehab center”)
medi-medi’s
older adults covered by medicare and medicaid
medicare
elders only, acute care emphasis, some evolution, complicated/hard to navigate
medicaid
any age, more social than health originally, limited long-term care emphasis, complicated/hard to navigate
Long-Term care Insurance
private long-term care insurance (LTC) aim to address gaps in home and skilled nursing care funding but do not cover all LTSS costs, EXPENSIVE
medi-gap
supplement insurance covers, medicare deductible and co-pays, items and services not covered by Medicare (hearing aids and eye glasses), charges exceeding amt approved by medicare
On Lok
first of models to integrate different sectors together into a single system of social care]]give support at home to people on the brink of nursing homes/rehab centers
