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Managed Markets Monday: Medicare, Medicaid and Health Care Reform


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In this Managed Markets Monday segment, we take a deep dive into the differences between Medicare, Medicaid and the impact on both from Health Care Reform.

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Managed Markets Monday: Medicare, Medicaid and Health Care Reform

  1. Medicare and MedicaidAn Overview
  2. Medicare and Medicaid • Government funded health programs for United States citizens who would be otherwise uninsured • Created in July 1965 as part of President Lyndon Johnson’s “Great Society” reforms • Programs have expanded to cover gaps in the private insurance system • Account for approximately $800 billion in federal spending per
  3. Comparative overview Medicare Medicaid For those 65 and over or those with For citizens below a certain income certain disabilities threshold or those with certain disabilities Financed through social security taxes and Funded in cooperation between state and beneficiary premiums federal governments Coverage benefits depend on which Many coverage benefits are federally program one is enrolled in, prescription mandated, but some (including drug costs are not covered by basic prescription drug benefits) are determined Medicare by statewww.nls/prg/conf/medicare-medicaid.htm
  4. Medicare
  5. What is Medicare?• A government funded health insurance program for people age 65 or older and people under 65 with certain disabilities or end-stage renal disease• Citizens are immediately eligible for Medicare when they reach age 65 if payroll taxes were contributed to Medicare throughout their working life• Covers approximately 45 million Americans• On average, half of enrollees’ health care costs are covered by
  6. What does Medicare cover? *Medicare is divided into 4 parts Medicare Part A Covers Medicare Part B Covers • Inpatient care in hospitals • Outpatient care • Inpatient care in nursing facilities • Physical and occupational therapy • Hospice care • Doctor’s services • Some home health care • Drugs incident to a physicians visit Medicare Part C Covers Medicare Part D Covers • Access to a plan from a private • Prescription drug costs (offered on health insurance program approved a state-by-state basis, must enroll by Medicare (Medicare Advantage in Medicare advantage plan) Program)
  7. Summary of government payers Medicare Medicaid Duel eligible • Elderly • Poor • If you are • Disabled • Young elderly or • Some disabled and disabilities poor or young
  8. How is Medicare financed? Part A Funded through a tax on the earnings of employers and their employees Funded by government revenues and premiums from higher-income Part B beneficiaries Part C Under Parts A, B, and D, and is therefore not funded separately Funded through government revenues and premiums from higher income Part D
  9. Medicaid
  10. What is Medicaid?• A health insurance program operated by the state for low-income citizens, those with physical or mental disabilities, and seniors• Covers approximately 60 million Americans including more than 1 in 4 children – Covers more people than any other private or public insurance program – Largest provider of coverage for long-term care; covers the majority of nursing home residents• Enrollment – Greatly increased since the recent economic downturn – Grows at an average annual rate of
  11. What does Medicaid cover? Federally Mandated Services State Optional Services • Hospital services • Prescription drugs • Physician’s services • Dental and vision services • Family planning services • Rehabilitation and physical therapy • Screening and x-ray services • Hospice services • Nursing home facilities • Inpatient psychiatric services • Some home health care • Transportation and translation
  12. How is Medicaid financed?• Funded through a partnership between state and Federal governments• Federal government matches state Medicaid spending – The amount of funds matched depends on the state’s per capita income, with poorer states receiving more federal
  13. Medicare, Medicaid, and HealthCare Reform
  14. Effects of Reform on Medicare• Coverage gap in Medicare Part D will be eliminated to ensure enrollees have access to affordable prescription drugs• Cost sharing for preventative care and screenings will be eliminated• Funding to reduce Medicare fraud will be increased• National standards of quality and safety will be established to improve overall care• Long-term care will be more affordable• Life of the Medicare Trust Fund will be extended to reduce chance of
  15. Effects of reform on Medicaid• Eligibility to qualify for Medicaid will be expanded to include a substantially larger group of low-income citizens on a state-by-state basis – Federal government will pay all costs of the expansion beginning in 2014 – To accommodate the expansion, enrollment will be simplified and quality of care available under Medicaid will be
  16. Works referenced•••• expansion/index.html•••