2. What is Medicare
• Federal Health Insurance program to assist
people over the age of 65 and certain people
with disabilities.
• Was created in 1965 under the Social Security Act
• Helps individuals regardless of their income and
medical history.
• Because of this program people are living longer
and are able to prolong their career in the work
force.
(Hooyman, 2009)
3. Eligibility
• Medicare eligibility:
– U.S. citizen
– Over 65 years old
– Currently receiving social
security
– Or railroad retirement benefits
(What Medicare Covers, 2013)
4. Eligibility for the Disabled
• Disabled eligibility:
• U.S. citizen • Have received
• Under 65 years old disability from social
• Qualified under security
disability or medical
condition
(Medicare Eligibility, 2012)
5. 4 Main Benefits
• Part A: Hospital Insurance
– 99% of older population
• Part B: Supplemental Medical Insurance
– 97% of older population
• Part C: Medicare Advantage
– Includes both A and B plus some benefits
• Part D: Prescription Drugs
(Hooyman, 2009)
6. (Part A) Hospital Insurance
• When a inpatient stays at a hospital overnight
with food, tests and a room
• Financed through Social Security payroll tax
• Pays up to 90 days hospital care, nursing care,
rehab, and hospice care
• Beneficiaries charged copayments for hospital
stays over 60 days
• Inpatients pay 1068 dollar deductable fee
• Page 736
(Hooyman, 2009)
7. (Part B) Supplemental Medical
Insurance
• Covers physician, nursing services, x-rays, labs,
tests, vaccinations, etc.
• Financed through monthly premiums by the
beneficiary and also general tax revenues
• Has annual 135 dollar deductable
• Premiums and annual incomes are higher
• Pays 80% of outpatient services
(Hooyman, 2009)
8. (Part C) Medicare Advantage
• Beneficiaries that receive their benefits
through private health insurance plans
• Includes both part A and part B services along
with additional benefits
• This is not a fee-for-service program
• Premiums are 50-100 dollars a month
(Hooyman, 2009)
9. (Part D) Prescription Drugs
• Anyone eligible for part A or B can be eligible
for part D
• Must enroll in Prescription Drug Plan or
Medicare Advantage plan
• Plans choose which drugs to cover and at
what level they will cover it, and which they
will not cover
(Hooyman, 2009)
10. Reduce Medicare cost
Biggest issue is that health care cost is rising
and the number of tax payers and
beneficiaries are decreasing. Pg 743
• Strategies:
• Increase eligibility age
• Use income test for eligibility
• Boost payroll tax
• Increase premiums for Part B
• Reduce service coverage and
reimbursements
(Hooyman, 2009)
11. References
Hooyman, Nancy R., and H. AsumanKiyak. "Ch. Social
Policies to Address Social Problems." Social Gerontology:
A Multidisciplinary Perspective. Boston: Allyn and Bacon,
1988. N. pag. Print.
"Medicare Eligibility." Planperscriber.com. N.p., 1 Aug. 2012.
Web. 11 Apr. 2013.
<http://www.planprescriber.com/medicare-eligibility/>.
"What Medicare Covers." Medicare.gov: The Official U.S.
Government Site for Medicare. N.p., n.d. Web. 11 Apr.
2013. <http://www.medicare.gov/what-medicare-
covers/index.html>.
