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27 Cards in this Set
- Front
- Back
% GDP healthcare used in the US in 80s vs 2010
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9% to 17%
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Reasons for increased HC expenditure, percentage used by elederly
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population aging, technology advancements and incerased reliance on.
34% |
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When medicaid and medicare passed?.
Financed by gov but provided... |
1965
privately, by hospitals and facilities |
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Medicare provides AD
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Acute care, (hospital, physician)
and drugs for elderly and disabled |
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Entitlement program
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People contribute through taxes and are entitled to benefits regardeless of income and assets
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How is medicare financed?
P B(acc) G (post bacc, gee) |
-Payroll taxes (1.45% which is also matched by employer)
-Beneficiaries (through annual deductible, co-payment and coinsurance) -General tax revenue |
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Medicaid A B C and D
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A = hospital/nursing/hospice
B= other (physician, outpatient, ER/ambulance, Home health) C= "choice" advantage plan. Optional managed care, better preventive D= drugs |
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Part A covers then copays how long for hospital?
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-First 60 days hosptial = covered after $1068 deductible
-Days 61-90 dovered with $267/day copay |
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Skilled Nursing Facility requirement
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only after a 3-night hospital stay, and only for acute care in nursing facility
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Part A nursin home payment
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Fully paid first 20 days
$133.50 copay for days 21-100 |
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Part A Home Health and Hospice payment
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-Fully cover 100 home health visits following hospital
-Fully paid hospice terminally ill |
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Part B parts (A OUL)*
(A owl) |
Ambulance and ER services
Outpatient services Unlimited Physician care Limited Home Health (if not post-hospital) |
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Part B payment (MAC)
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Monthly premium ($106+/month)
Annual deductible $135 Coinsurance of 20% per service |
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Part C Info/Payment
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Optional managed care plan (no ABD if chosen)
Fully cover wide range services, especially preventive but no nursing home and stuff |
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Part D info / started when
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-voluntary prescriptions drug benefit
-started 2006 |
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Part D payment
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-Monthly premium $25/month
-Annual deductible $295 after which covers 75% of Drug costs til $2700 then hole until $6154 |
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Medicare limitations* (Veldh)
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No covers:
-Vision and eyeglass -experimental treatment -LTC -Dental care -hearing aids (cost thousands) |
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Other costs with Medicare
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-No limitation on out of pocket spending
-Medigap insurance policies ($150/month (private to cover remainder of medical bills) |
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Total Medicare cost breakdown
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$281 /month (B+D+gap premium)
+ any copya, deductive, out of pocket |
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Prospective Payment System - Hospital
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(1983) hospitals only receive fixed amount for a specific diagnosis
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Diagnostic related group
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over 500 DRGs, are used to determine payment for PPS
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Prospective Payment System - Skilled nursing facility
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based on case-mix, classify pateints based on 44 resource utilization groups (so sicker = more $)
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Ways to reduce medicare costs (COPE)
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Covered Services less
Out of pocket more Pproviders less payment Eligibility age to 67 |
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Medicaid funded by?
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Federal government to provide healthcare for the poor
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Means-tested Medicaid requirements
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Qualify based on income/assets regardless of age ...
-<$11k/year, <2k in assets (not include house) |
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Medicare paid by state/gov?
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50/50, biggest state expenditure though
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Medicade covers what %elderly, what kinda care?
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12% of elderly (tho thats 75% of budget)
-pays for LTC, esp institutional |