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Social security and medicare & medicaid spring 2013

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Social security and medicare & medicaid spring 2013

  1. 1. Social Security and Medicare & Medicaid NURS 4100 Care of the Older Adult Spring 2013 Joy A. Shepard, PhD(c), MSN, RN, CNE1
  2. 2. Objectives  Analyze the benefits of Social Security  Discuss the phenomenon of retirement as it relates to an aging society  Compare and contrast the Medicare and Medicaid programs  List the benefits and barriers to long- term care insurance2
  3. 3. Changing Demographics3
  4. 4. Changing Demographics  Year 2001  Year 2021  Year 20114
  5. 5. Age & Sex Structure of the US Population: 2010, 2030, & 20505
  6. 6. Shifting Composition of the Workforce6
  7. 7. Social Security7
  8. 8. Social Security  Social Security Act of 1935  Federal public retirement pension system  Full retirement age steadily rising (since 1980s)  Has decreased poverty rates  Major recipients female elderly  No means test  Qualifications  Financially sustainable?  Procrastination – bad policy  What suggestions do YOU have to save Social Security?  Text of the 1935 Social Security Act8
  9. 9. 9
  10. 10. Review Question  Which of the following factors would not threaten the solvency of Social Security?  A. Baby Boomers taking early retirement.  B. Means testing being implemented for Social Security.  C. Another recession or depression.  D. Aging of the population.10
  11. 11. Retirement in an Aging Society11
  12. 12. Retirement  Phenomenon of retirement – How will it be redefined by the Boomers?  Decades of retirement - feasible?  Social Security sufficient?  Are Boomers prepared?  “Third Age” career strategies12
  13. 13. Medicare & Medicaid13
  14. 14. President Lyndon Johnson Signing Medicare Bill: July 30, 196514
  15. 15. Medicare  Title XVIII of the Social Security Act (1965)  Covers elderly and some disabled – Part A – Hospital insurance – Part B  Supplemental medical insurance (physician care)  Preventive services  Limitedmeans test  Covers ~ 45% of elders’ medical care bills15
  16. 16. Medicare Preventive Services  Prevention is any activity that reduces the burden of mortality or morbidity from disease. Services performed in a clinical setting that are designed to prevent disease, injury, or disability, prolong life, and promote health are known as preventive health services.  Examples: Screening, testing, counseling, immunization, preventive medication, and preventive treatment.  Help people avoid disease or injury (primary), delay the onset of disease (primary), detect disease in its earliest and most treatable state (secondary), or alter and change the course of chronic conditions by restoring function and reducing complications (tertiary).  Result: Longer, healthier, and more productive lives.16
  17. 17. Medicare Preventive Services (Part B):  One-time “Welcome to Medicare” preventive visi vis  Abdominal aortic aneurysm screening  Alcohol misuse screenings and counseling  Bone mass measurements (bone density)  Cardiovascular disease screenings  Cardiovascular disease (behavioral therapy)  Colorectal cancer screenings  Depression screenings  Diabetes screenings17
  18. 18. Medicare Preventive Services Cont’d…  Diabetes self-management training  Glaucoma tests  HIV screenings  Mammograms (screening)  Nutrition therapy services  Obesity screenings and counseling  Pap tests and pelvic exams (screening)  Prostate cancer screenings  Sexually transmitted infections screening and cou18
  19. 19. Medicare Preventive Services Cont’d…  Shots: – Flu shots – Hepatitis B shots – Pneumococcal shots  Tobacco use cessation counseling  Yearly "Wellness" visit  http://www.medicare.gov/coverage/preventive-and-screening-servic19
  20. 20. Medicare Related Resources Medicare & You: Stay Healthy with Medicare & You: Womens Prevent20
  21. 21. Medicare  Medicare Advantage – Part C  Voluntary Prescription Drug Benefit – Part D21
  22. 22. 22 http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2012.pdf
  23. 23. Question Hospital insurance for Medicare recipients is funded under: – A. Medicare Part A – B. Medicare Part B – C. Medicare Part C – D. Medicare Part D23
  24. 24. Medigap – Medicare Supplemental Insurance Policies  Medicare Supplemental Insurance  Private insurance – helps seniors pay for costs not covered by Medicare24
  25. 25. 25
  26. 26. Medicare Covers (with some limitations): – Skilled nursing in nursing facilities and subacute care – Home health care – Hospice26
  27. 27. Medicare no longer covers the cost of 10 hospital-acquired conditions  Foreign object  Poor glycemic control retained after surgery  Catheter-assoc UTI  Air embolism  Vascular catheter- associated infection  Blood incompatibility  Certain surgical site  Stage III & IV pressure infections (CABG, ulcers bariatric, orthopedic)  DVT or PE following  Falls & trauma TKR, hip replacement For more information, please see http://www.cms.hhs.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp#TopOfPage27 http://www.cms.hhs.gov/apps/media/press/factsheet.asp? Counter=3227&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&p
  28. 28. Review Question  Medicare recently issued a new ruling. It will cease paying for 10 preventable hospital- acquired conditions. Which of the following conditions are included in the new ruling? – A. Hematoma after venipuncture – B. Skin tear after being turned and repositioned – C. Cellulitis after IV infusion – D. Pneumonia after aspirating on meal tray28
  29. 29. Medicaid  TitleXIX Social Security Act (1965)  Covers “medically indigent”  Funded partly by federal and partly by state governments  Run by states under federal guidelines  North Carolina statistics North Carolina Medicaid State Plan North Carolina Division of Medical Assistance29
  30. 30. Latest Data: NC Medicaid Enrollments & Payments  Rising Enrollments  Federal Share/ State Share: 71.81%/28.19%30
  31. 31. Medicaid Covers (depending on state’s program): – Nursing care facilities – Assisted living – Home health31
  32. 32. Affordable Care Act of 2010 Expands Medicaid Eligibility in 2014  The Affordable Care Act of 2010, signed by President Obama on March 23, 2010, creates a national Medicaid minimum eligibility level of 133% of the federal poverty level ($29,700 for a family of four in 2011) for nearly all Americans under age 65.  This Medicaid eligibility expansion goes into effect on January 1, 2014 but states can choose to expand coverage with Federal support anytime before this date-see related Federal Policy Guidance and states that have expanded Medicaid prior to 2014.  States can also choose to opt out of the expansion.  See eligibility provisions in the Affordable Care Act. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html32
  33. 33. 33
  34. 34. Review Question What is federally mandated and state administered? A. Medicaid B. Medicare34
  35. 35. Review Question  _________ is a $432 billion public health insurance program for low- income individuals and the largest long- term care program for the disabled and elderly.  A. Medicaid  B. Medicare35
  36. 36. Review Question Which of the following applies to Medicare and which applies to Medicaid?  A. Federally administered, nationwide healthcare coverage program for elderly/ disabled  B. Entitlement program—all individuals have a legal right to apply for the program; if they meet the eligibility criteria, they are entitled to receive coverage  C. Uniform: one set of requirements applies to all participating providers/ beneficiaries  D. Joint federal/ state partnership: healthcare coverage for low-income individuals  E. Differences among state programs: covered populations, benefits, cost sharing, delivery systems and reimbursement to providers  F. Means-tested program that provides benefits to certain categories of people who meet rigorous income and asset rules  G. States may cover other individuals under “waiver” programs  H. Every state has a limit on what things (“assets”) a recipient may own and keep36
  37. 37. Ethical Issue: Transfer of Assets & “Spend Down”  Is transferring assets to qualify for Medicaid ethical?  Right to leave assets to children?  Should wealthy be subsidized?  Punished for being frugal?37
  38. 38. Long-Term Care Insurance38
  39. 39. Long-Term Care Insurance Plan ahead for LTC costs Mainly people over age 55 4-10% older population covered Provides 7% of total funding for LTC39

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