The Practical Playbook - Medicare and Medicaid

Question 1

How does U.S. healthcare spending compare to other high-income countries?

Answer 1

At $9,000+ per capita, the average is more than twice that of most comparable countries.

Question 2

Who qualifies for Medicare (3 categories)?

Answer 2

Individuals ≥ 65 yoa

Individuals < 65 yoa if certain disabilities

Individuals with end-stage renal disease

Question 3

When should a typical individual apply for Medicare?

Answer 3

3 mo. before turning 65

(Automatic if receiving Social Security or Railroad Retirement benefits)

Question 4

What are Medicare Parts A, B, and D?

Answer 4

Part A - Hospital insurance (Inpatient, skilled nursing, home health, hospice)

Part B - Medical insurance (Preventative, diagnostic, and outpatient care; durable medical equipment)

Part D - Prescription drug coverage (Outpatient)

Question 5

How much are Medicare A premiums? Is there a deductible?

Answer 5

Usually premium-free (Unless you’ve been paying into the system for less than 10 years)

$500-800 deductible for hospital stays (Up to 60 days) Some other deductibles apply for other services

Question 6

How much are Medicare B premiums? Is there a deductible?

Answer 6

$130 per month (As of 2017)

$130 deductible per year (As of 2007)

+ 20% copay

Question 7

What are some of the Medicare options?

Answer 7

Medicare plan (Original)

Advantage plans

Prescription drug plans

Other plans

Question 8

What is Medigap?

Answer 8

Private insurance that helps to cover copays and deductibles (Not applicable to Advantage plans)

Monthly premium

Question 9

What are some of the Medicare Advantage plans?

Answer 9

Health Maintenance Organizations (HMO) plans

Preferred Provider Organizations (PPO) plans

Private Fee-For-Service plans

Special needs plans

Question 10

Describe Medicare Advantage plans eligibility requirements.

Answer 10

• May have required service providers in the plan
• Continue to pay Part B premium + maybe a new premium for the plan (Entitled to Part A)
• May get extra benefits

Question 11

What happens if you enroll late in Medicare?

Answer 11

Additional 1% of the national base premium for every month eligible but not enrolled

Question 12

What percentage of Medicare is paid for by general revenue? What percentage of Medicare is paid for by payroll taxes? What percentage of Medicare is paid for by beneficiary premiums?

Answer 12

41%

38%

13%

Question 13

Where does the bulk of Medicare Part A funding come from?

Answer 13

Beneficiary premiums (88%)

Question 14

Where do the bulks of Medicare Parts B and D funding come from?

Answer 14

General revenue (73%)

Question 15

Is Medicare solvent?

Is it sustainable?

Answer 15

Yes.

No.

Question 16

Who is eligible for Medicaid?

Answer 16

Varies on a state-by-state basis

General rule: (Must be indigent) Low-income individuals who are aged, blind, disabled, members of families with dependent children, and some pregnant women

Question 17

How much did Medicaid cost overall the Federal gov. in 2017?

Answer 17

$350 billion

(1/10 of overall U.S. budget) (State funds pay 64%)

Question 18

How much of Medicaid is spent on nursing home care?

Answer 18

34%

(70% for individuals ≥ 65 yoa)

Question 19

What percentage of average state spending went to Medicaid in 2014?

Answer 19

25%

Question 20

What is the Children’s Health Insurance Program (CHIP)?

Answer 20

A Medicaid-like partnership between Federal and State gov. Covers cost for children in low-income families (≤ 200% of the U.S. poverty line)

Question 21

What are Community Health Centers? How many are there in the U.S.?

Answer 21

Community-based and patient-directed care for low-income individuals.

~1400

Question 22

What percentage of the U.S. population is on government-funded health care?

Answer 22

47%

150 million / 330 million

Question 23

What are some examples of U.S. government-funded health care programs?

Answer 23

Medicare

Medicaid

CHIP

Community Health Centers

VA

Indian Health Services

Active duty military