PAM- Medicare
Who does medicare cover?
elderly
disabled
ESRD patients
What were the effects of medicare?
dropped uninsured rates
poverty rates decreased during this time period
Parts of Medicare
A: hospital in patient; skilled nursing facility; home care
B: Physician services; outpatient/same-day facility - $170
C: Medicare Advantage Health Plan
D: Prescription drugs - $33
What does medicare not cover?
nursing home care
dentures and dental care
eyeglasses
hearing aids
How is supplemental health insurance used?
Medicare enrollees use other plans to supplement insurance coverage
Part C paid by Center of Medicare/Medicaid Services
pays most of Part C premium to private health insurer
managed care plan- has smaller set of physicians offered
How is Medicare financed?
PART A
PART B & D
HOSPITAL CARE
pay as you go system
current workers pay for current retirees
employees and employers split payroll tax- 2.9% and + .9% for high income workers
PHYSICIANS AND DRUGS
federal tax revenue covers 72% of the costs
elderly premiums cover the rest of the costs with high income individuals paying more
going to run out by 2028
Issues with Medicare
Medicare spending keeps increasinng
fewer baby boomers paying taxes
elderly advantaged by medicare due to spending
What are the repercussions of Medicare costs continuing to grow?
more people are retiring; elderly living longer; medical costs are rising
if we wait, taxes would have to increase astronomically
other taxes would have to increase
government would cut other programs or go into more debt
Possible Medicare Restructuring Policies
increase eligibility age from 65 to 67
Increase premiums for part B and part D
raise payroll tax by 1%
medicare into premium support plan; everyone turns into part C
change cost sharing rules for medicare and restrict medigap
PAM-Medicaid
Federal government establishes minimum requirements for the Medicaid program
Each state decides what to include beyond federal government requirements; determines how to pay for its share of cost; determines how much to pay physicians and hospitals; ADMINISTERS PROGRAM
Federally mandated groups:
Young children: 0-17
Pregnant women ( < 133% of poverty line)
NOT FEDERAL: Low income adults depending on state
blind and disabled with low income
low income Medicare beneficiaries
levels of restriction
Restrictive states: adults without children are not eligible for medicaid
Some restrictions: parents are eligible if income is less than 50% of poverty line
Expansive states: adults eligible if income is <133%
What does Medicaid cover?
hospital care
outpatient care
long term nursing home care
home care
lab tests and other medical benefits
OPTIONAL: prescription drugs
Medicaid basic facts
enrollment has quadrupled
spending has increased
spends least amount on children and most on disabled
elderly, blind, and disabled make up 50% of medicaid spending
Medicaid for children has led to long term improvements in health; government makes $2 for every $1 spent in Medicaid
Medicaid Spending
federal government's share of spending is based on state's per capita income
fed gov pays 60% of overall Medicaid nationaly
states spend twice as much on Medicaid than higher education
Medicaid and Physicians
Medicaid pays MD's 50% less than private insurers do; pays hospitals 46% less
Reprucussions:
physicians don't accept new medicaid patients- 36% denied in 2015
Medicaid VS the Block Grant System
What is block grant system?
What are the advantages of this system?
What are the disadvantages of this system?
Much like capitation: Federal government provides fixed amount of money to states based on some formula; states would then decide what to cover
rise at rate of inflation
account for population growth
14-27 million fewer people would have been covered
would've saved $800B by repealing ACA expansions and growing grants at less than the medical cost growth rate
would have addressed social determinants of health