NOT ON STUDY GUIDE FOR EXAM 3 - Week 11: Economics

Question 1

Social Security

Answer 1

Established in 1935 to provide monetary benefits to older retired workers as a means to prevent or minimize their dependency on younger members of society.

Question 2

Supplemental Security Income

Answer 2

Established in 1965 to provide a minimum level of economic support to persons age 65 and over, blind, or disabled regardless of their earning power in early life or when capable of working.

Question 3

Other Late Life Income

Answer 3

• May come from private retirement investments or employer pensions
• These monies are held for the beneficiary until such time when they must begin to “withdraw” some portion, at the age determined by the fund.

Question 4

Economics and Health Care: Medicare

Answer 4

• Specifically designed to provide almost universal health care for those who are eligible for Social Security.
• As soon as one is 65 years old, he or she is automatically enrolled in Medicare Part A; Medicare Parts B, C, D are selected on personal preference and availability.
• “Wellness visits” are available every 12 months after the initial examination (Box 30-7; pg. 411).

Question 5

Medicare Part A

Answer 5

Is a hospital insurance plan covering acute care, short-term rehabilitation in a skilled nursing facility or at home, and most costs associated with hospice care (Box 30-8; pg. 412).

Question 6

Medicare Part B

Answer 6

• Based in part on income reported to the IRS.
• Provides insurance coverage for many services provided on an outpatient basis, such as visits to providers (Box 30-9; pg. 412).
• Choice of primary care provider and referrals not usually necessary.
• Providers who “accept assignment” agree to charge only the “allowable” fee that Medicare determines.

Question 7

Medicare Part C

Answer 7

• Referred to as Medicare Advantage Plans.
• Uses a prospective payment system to include traditional health maintenance organization (HMOs) and other managed plans.
• All traditional services covered by Medicare Parts A & B must be provided, and additional services, co-pays, and deductibles are predetermined.
• No care is obtained without a referral from the assigned primary care provider.

Question 8

Alternatives to Medicare C

Answer 8

Private Fee-for-Service Medical Savings Account (federal government makes monthly payments directly into the person’s own private savings account and when health services are obtained the individual pays for them directly). Comes with high deductibles!!!

Question 9

Medicare Part D

Answer 9

• The Medicare Modernization Act of 2003 established a Medicare Prescription Drug Plan (PDPs) benefit for eligible recipients of Medicare (Box 30-10; pg. 413).
• It is an elective prescription drug plan with associated out-of-pocket premiums and co-payments.

Question 10

Medicaid

Answer 10

• Covers the cost of health services for low-income children, pregnant women, those who are permanently disabled, and persons age 65 and older who meet the states eligibility criteria.
• The majority of Medicaid funds are used to provide long-term nursing home care for older or disabled adults.

Question 11

How is Medicaid eligibility determined?

Answer 11

Eligibility is determined by the state and is based on income and assets, categorical need, and lack of ability to afford any insurance premiums, including those associated with Medicare.