History of Medicare 1948 Harry Truman 1950 Social Security officials realized older Americans were facing a health care crisis. 1950-1963 =

History of Medicare 1948 Harry Truman

1950 Social Security officials realized older Americans were facing a health care crisis.

1950-1963 = population grew 12 million to 17.5 million.

Costs rising = 6.7 percent a year

1963 Five big states 32 percent of population

took up 90 percent of federal funds.

History of Medicare Continued

1965 Lyndon B. Johnson House and Senate passed the Medicare

bill

1972 Medicare eligibility was extended

Medicare Overview

The centers for Medicare and Medicaid Services administer Medicare

Medicare = Two Parts Part A Hospital Insurance (HI) Part B Supplementary Medical

Insurance (SMI)

Medicare OverviewPart A

Hospital Insurance helps payHospital Insurance helps pay1. Inpatient hospital care = covers 90

days of impatient hospital services in each “benefit period” plus an additional 60 “lifetime reserve days”

$840 deductible for first day Past 60 days = $210 per day for days 61-

90 Past 91st day – 150th day = $420 per day

co-payment

Medicare Overview Part A Continued…

2. Care in a skilled nursing facility = for each benefit period if all Medicare requirements are met

Covered up to 100 days Pays in full for the first 20 days In 2003 mandatory co-payment of $105

for days 21-100


3. Home Health Services = covered up to 100 visits per spell of illness following a hospital stay.Requirements:

Patient is homebound A need for intermittent skilled nursing or

therapy services exists. Services are provided by a Medicare

certified home health agency.


4. Hospice Care = keep the patient as comfortable as possible

No treatment provided

Part A Free if you qualify Exception: Voluntary

enrollees

Medicare Overview Part B

Supplementary Medical Insurance Supplementary Medical Insurance helps pay for helps pay for Doctors Outpatient hospital care Occupational and physical therapy Laboratory tests and X-rays Durable medical equipment

Medicare Overview Part B Continued…

Part B coverage is voluntaryPart B coverage is voluntary Monthly premium = $66.60

Additional costsAdditional costs $100 deductible 20 percent coinsurance payment Excess charges Some outpatient services

Medicare Overview Part B Continued…

What Part B doesn’t coverWhat Part B doesn’t cover Eyeglasses

Outpatient prescription drugs

Hearing aids

Dental care

Medicare Eligibility

Part A Hospital Insurance If you are at least 65

years old You or your spouse

worked at least 10 years in Medicare covered employment

You are a citizen or permanent resident of the United States

Medicare Eligibility Continued…

Part A Cont’d Premium Free at age 65

Already receiving retirement benefits from Social Security or the Railroad Retirement Board

Are eligible to receive Social Security or Railroad benefits but have not yet filed

Your spouse had Medicare covered government employment


Part A Cont’d Under 65 without

paying premiums Have received Social

Security or Railroad Retirement Board Disability Benefit for 24 months

Are a kidney dialysis or kidney transplant patient


Part A Cont’d State Programs that

pay premiums for you Must have part A Have assets, such as

bank accts, stocks, and bonds that are not more than $4,000 for single person or $6,000 for couples

Have a monthly income that is below certain limits


Part B Medical Insurance All the eligible

candidates for Part A are eligible for part B

must be purchased additionally

United States Population

Demographics Median age 35.3 in

2000 opposed to 32.9 in 1990

Population from 45-54 swelled 49 percent from 1990-2000

Pop. From 65-74 rose from 31.2 to 35 million since the 1990 census to the 2000 census

Options under Medicare

Medigap Insurance

Medicare Select

Medicare+Choice

Medigap Insurance

What is it? Medigap is insurance to help cover

gaps in Medicare.

“A – J” Standardized Plans Benefits covered in one plan are the

same regardless of which carrier offers it.

Medigap PlansMedigap Benefit A B C D E F G H I J

Part A Deductible

Part B Deductible

Part A and B Coinsurance

Part B Excess - Above Medicare's Approved Amount

Basic Drug Benefit ($1,250 Limit)

Extended Drug Benefit ($3,000 Limit)

Foreign Travel Emergency

At-Home Recovery

Skilled Nursing Coinsurance

Preventative Care

365 Extra Days of Hospital Coverage

3 Pints of Blood

Medicare Select

What is it? Same as Medigap insurance, however

stipule involved. Differences with Medigap

Requires you to use their network of providers.

Medicare+Choice Plans

HMOs PPOs PSOs PFFS

Medicare Modernization Act of 2003

1st = Medicare approved drug discount cards

2nd = Medicare Advantage3rd = New and improved preventive

benefits4th = Prescription drug benefit

Issues with Medicare

Projected to be bankrupt in 2026 A problem caused by paying out more

money then how much is receiving.

Savings are being eroded by increasing prices

Politics

Suppressed the numbers Fuel for the democratic party

John Kerry

Major problems occurring

Social Security Administration (SSA)

Currently 2.7 percent of GDP is the cost of Medicare

In 2078 Medicare costs projected to reach 14 percent of GDP

Strains on Medicare Medicare Modernization Act of 2003 Increasing costs of healthcare Low tax income and high expenditures

Recommendations

Prescription costs

Modifications to Modernization Act

US Prescription Drug Prices vs. Canadian’s

Prices

Lipitor United States = $272 - $308 Canada = $159 - $199

Zocor United States = $372 - $451 Canada = $198 - $224

US Prescription Drug Prices vs. Canadian’s Prices Continued…

Celebrex United States = $145 - $177 Canada = $63 - $71

Documents

History of Medicare 1948 Harry Truman 1950 Social Security officials realized older Americans were facing a health care crisis. 1950-1963 =