#healthcare2

Module Overview

Medicare

Medicare is a federal insurance program operated under the oversight of the  Center for Medicare and Medicaid Services (CMS), a branch of the U.S. Department of Health and Human Services (DHHS).

The Medicare program, also referred to as Title XVIII of the Social Security Act of 1965, finances medical care for

· persons 65 and over,

· disabled people who are entitled to Social Security benefits,

· people who have end-stage renal disease, and

· people who have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig’s Disease

Please view the 12-minute tutorial on Medicare at www.kaiseredu.org/tutorials/Medicare%20101/Medicare101.html

See the PowerPoint presentation about Medicare 101 .

Here’s an overview of the Medicare Timeline, adapted from the Medicare Chart Book 2005 at http://www.kff.org/medicare/7284.cfm

1965

President Johnson signed the law to establish Medicare for the elderly and Medicaid for the indigent in the presence of Harry S. Truman who had advocated for such legislation in a message to Congress in 1945. President Truman was the first to enroll in Medicare.

1966

Medicare coverage began. All persons age 65 and over were automatically covered under Part A (Hospital Insurance). Coverage began for seniors who signed up for the voluntary medical insurance program (Part B). More than 19 million individuals ages 65 and older were enrolled in Medicare.

Medicare Part A deductible: $40/year

Medicare Part B premium: $3/month

1972

President Nixon signed the Social Security Amendments of 1972, the first major adjustment to Medicare after its enactment. Medicare eligibility was extended to individuals under age 65 with long-term disabilities (who were receiving SSDI payments for two years) and to individuals with end-stage renal disease. By 1973, nearly 2 million people under age 65 with long-term disabilities or end-stage renal disease were covered.

1997

The Balanced Budget Act of 1997 (BBA) included a broad range of changes in provider payments to slow the growth in Medicare spending as part of legislation to balance the federal budget. It also established the Medicare+Choice program, a new structure for Medicare HMOs and other private health plans offered to beneficiaries.

1999

The Balanced Budget Refinement Act of 1999 was enacted to restore some of the funding that was cut from the BBA of 1997. This points to how difficult it was for legislators to anticipate the unintended consequences of the 1997 BBA.

2003

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was signed into law by President Bush, providing a new outpatient prescription drug benefit under Medicare beginning in 2006.

The law also established a new income-related Part B premium for beneficiaries with higher incomes (beginning in 2007), and created regional PPOs under the Medicare Advantage program (previously Medicare+Choice), and established financial and other incentives for private health plans to contract with Medicare.

2005

Medicare began covering a “Welcome to Medicare” physical, along with other preventive services, such as cardiovascular screening blood tests and diabetes screening tests.

Medicare Part A deductible: $912/year

Medicare Part B premium: $78.20/month

Total Medicare population: 42.3 million beneficiaries

2006

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies. Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.

Like other insurance, people who join will pay a monthly premium, which varies by plan, and a yearly deductible (no more than $250 in 2006). They will also pay a part of the cost of prescriptions, including a copayment or coinsurance. Costs will vary depending on which drug plan they choose.

Almost 1 in 3 people with Medicare will qualify for extra help (based on income) and Medicare will pay for almost all of their prescription drug costs.

Medicaid

The Medicaid program, also referred to as Title XIX of the Social Security Act, is a cooperative state-federal program that finances health care services for a segment of the population that are referred to as indigents (those who lack health insurance and cannot afford to purchase or otherwise obtain health care insurance). Unlike Medicare, the Medicaid program is jointly funded by the federal and state governments, and is administered by state governments.

There is an extremely important public policy distinction between Medicare and Medicaid: Medicare is an entitlement program because people have contributed to the system through taxes. Consequently, those eligible receive Medicare benefits regardless of their income or assets. On the other hand, Medicaid is a welfare program based on financial need. Income and assets impact eligibility for Medicaid.

Please view the 17-minute tutorial on Medicaid, available at http://www.kaiseredu.org/tutorials/medicaidbasics/medicaid.html

Read this PowerPoint presentation about Medicaid: The Basics .

Required Reading

Centers for Medicare & Medicaid Services (2007). Overview. Retrieved from http://www.cms.hhs.gov/MedicaidGenInfo/ .

Guterman, S., Davis, K., Stremikis, K., & Drake, H. (2010). Innovation in medicare and medicaid will be central to health reform's success. Health Affairs, 29(6), 1188-93.

Hill, J.E. (2006). The Coming Revolution in Healthcare. Vital Speeches of the Day, 72(26), 774-777.

Kaiser Family Foundation (2002). Fact Sheet on Children’s Health—Why Health Insurance Matters. Retrieve from http://www.kff.org/uninsured/4055-index.cfm . Click on the Fact Sheet link on the page.

Shaefer, H. L., Grogan, C. M., PhD., & Pollack, H. A., PhD. (2011). Who transitions from private to public health insurance? lessons from expansions of the state children's health insurance program. Journal of Health Care for the Poor and Underserved, 22(1), 359-70.

Required Websites

Kaiser Family Foundation (2002). Medicare Basics Tutorial (12-minute audio presentation). Retrieved from http://www.kaiseredu.org/tutorials/Medicare 101/Medicare101.html .

Kaiser Family Foundation (2002). Medicaid 101 Tutorial (17-minute audio presentation). Retrieved from  http://www.kaiseredu.org/tutorials/medicaidbasics/medicaid.html .

Optional Reading

Kaiser Family Foundation publishes fact sheets highlighting key facts and statistics about the Medicare program, including "Medicare at a Glance," "The Medicare Prescription Drug Benefit," "Medicare Spending and Financing," and "Medicare Advantage."

Kaiser Family Foundation (2005). Enrolling Uninsured Low-Income Children in Medicaid and S-CHIP. Retrieved from http://kff.org/medicaid/fact-sheet/enrolling-uninsured-low-income-children-in-medicaid/ .