Module 7 lecture, part 4 Flashcards
What is Medicare part C?
Medicare advantage
Hx of Medicare part C
Began as Medicare + Choice in 1997 then renamed Medicare Advantage in 2003
-No additional svcs, but additional health plan choices
-To channel into managed care for Parts A and B
-Can choose to remain in original Medicare program
Aspects of Medicare part C
Pay additional premiums
Additional benefits
No need for Medigap
Lower out of pocket costs
What aimed to reduce payments to Medicare Advantage plans?
The ACA
What is Medicare part D?
Prescription drug coverage
When was Medicare part D implemented?
2006
What can enrollees choose between for Medicare part D?
Stand-alone plans for prescriptions only
Part C (all svcs through managed care)
Payment in Medicare part D
Requires payment of a deductible
Three levels of out-of-pocket costs after deductible in Medicare part D
Basic level
Coverage gap (doughnut hole)
Catastrophic level
What is another component of part D, that’s also a component of part B?
Higher income leads to paying more, IRMAA
What was eliminated by 2020 in terms of Medicare part D?
Coverage gap by the ACA
Aspects of Medicare out of pocket costs
Relatively high deductibles, copayments, and premiums
No eyeglasses, dental, long-term care coverage
No limit on out of pocket expenses in the original Medicare program
-Exception: a half of the Medicare Advantage plans have cost sharing limits
-A typical beneficiary spends about 20% of income on out of pocket costs
What fraction of national healthcare expenditures is consumed by Medicare?
1/5
Trends of heath insurance and supplemental Medicare insurance in 2012
Deficits
What is the future of Medicare?
Headed for insolvency unless it is steered around
What are the 3 main factors threatening future solvency of Medicare?
Rising cost of delivery HC
An aging population
Shrinking workforce to support tax revenues and smaller age increase than medical inflation
What constituted 80% of Medicare financing?
Payroll and general tax combined
Under what legislation is Medicaid?
Title XIX of the SSA
Who does Medicaid finance?
Indigent as determined by each state (means tested)
Who finances Medicaid?
Jointly financed by federal and state gov’ts
Who are dual eligible beneficiaries?
Eligible for both Medicare and Medicaid
Full duals for Medicare and Medicaid
Qualified for all benefits under both Medicare and Medicaid
Partial duals for Medicare and Medicaid
Some of the costs paid by Medicaid
What occurred in terms of Medicaid and the ACA?
Mandates got struck down by the Supreme Court
-Gave states a choice to either expand or not expand their Medicaid programs to 138% of the federal poverty level without penalty from the federal gov’t
Uncertain coverage and benefits for many low-income ppl
What were the 2 ironies of the Medicaid ACA strikedown?
Non-complying states don’t have to use the assets test to determine eligibility, resulting in that a millionaire can qualify for Medicaid based solely on low income
Preventive svcs at the states’ discretion for existing beneficiaries leads to inconsistent preventive svcs for Medicaid enrollees in the same state
