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27 Cards in this Set

  • Front
  • Back
% GDP healthcare used in the US in 80s vs 2010
9% to 17%
Reasons for increased HC expenditure, percentage used by elederly
population aging, technology advancements and incerased reliance on.
34%
When medicaid and medicare passed?.

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