Social Policy On Aging

Front 1

What is Medicare?

Back 1

Medicare is a federal entitlement program that provides health insurance coverage to 47 million people, including people age 65 and older, and younger people with permanent disabilities, end-stage renal disease, and Lou Gehrig’s disease.

Front 2

Who is eligible for Medicare?

Back 2

Individuals become eligible for Medicare when they reach age 65, if they or their spouse made payroll tax contributions for 10 or more years. People under age 65 qualify for Medicare after 24 months of receiving Social Security Disability payments, or if they have end-stage renal disease or Lou Gehrig’s disease.

Front 3

What does Medicare cover and how much do beneficiaries pay for benefits?

Back 3

Medicare covers basic health services, including hospital stays, physician visits, and prescription drugs. Many benefits are subject to deductibles and cost-sharing requirements. Medicare does not cover most long-term care services, vision or dental care, or hearing aids.

Front 4

What is the Medicare prescription drug benefit?

Back 4

Part D: Prescription Drugs Plan 27.6 mill enrollee.
Medicare helps cover the cost of prescription drugs offered through private drug plans. More than half of all beneficiaries are enrolled in a Part D drug plan, with 90 percent having some source of drug coverage.

Front 5

What is Medicare Advantage?

Back 5

Medicare Advantage plans - Part C.
- are private health plans that receive payments from Medicare to provide Medicare-covered benefits to enrollees. Nearly one-fourth of all beneficiaries are enrolled in a Medicare Advantage plan

Front 6

What types of supplemental insurance do beneficiaries have?

Back 6

Most beneficiaries have some type of supplemental insurance to help pay Medicare’s cost-sharing requirements and fill gaps in Medicare’s benefit package. Primary sources of supplemental coverage include employer-sponsored plans, Medicaid (for those with limited incomes and assets), Medigap policies, and Medicare Advantage plans.

Front 7

How is Medicare financed?

Back 7

Funding for Medicare comes primarily from general revenues (40 percent) and payroll taxes (38 percent), followed by premiums paid by beneficiaries (12 percent).

Front 8

How much does Medicare cost and how is the money spent?

Back 8

Medicare is estimated to account for 12 percent of federal spending in 2010. Inpatient hospital services comprise the largest share of Medicare benefit payments (27 percent), followed by payments to Medicare Advantage plans (24 percent) and physicians and other suppliers (18 percent). The drug benefit accounts for 11 percent of total payments.

Front 9

How is the health care reform law expected to affect future Medicare spending?

Back 9

The 2010 health care reform law includes a number of provisions that are expected to reduce the growth in Medicare spending over the next decade and beyond, thereby maintaining the solvency of the Medicare Part A (Hospital Insurance) Trust Fund through 2029.

Front 10

Medicare is the nation’s health insurance program for Americans age 65 and older, and for younger adults with permanent disabilities.

Back 10

Established in 1965 under Title XVIII of the Social Security Act, Medicare was initially established to provide health insurance to individuals age 65 and older, regardless of income or medical history. The program was expanded in 1972 to include individuals under age 65 with permanent disabilities receiving Social Security Disability Insurance payments and people suffering from end-stage renal disease (ESRD). In 2001, Medicare eligibility expanded further to cover people with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). As of 2010, 47 million people rely on Medicare for their health insurance coverage: 39 million people age 65 and over and 8 million people under age 65 with disabilities.

Front 11

Medicare consists of

Back 11

four parts, each covering different benefits.

Front 12

PART A, also known as the Hospital Insurance (HI) program

Back 12

covers inpatient hospital services, skilled nursing facility, home health, and hospice care. Part A is funded by a tax of 2.9 percent of earnings paid by employers and workers (1.45 percent each). The health care reform law3 increases the Medicare HI payroll tax for higher-income taxpayers (more than $200,000/individual and $250,000/couple) by 0.9 percentage points, beginning in 2013. In 2009, Part A accounted for approximately 36 percent of total Medicare benefit spending.4 An estimated 45.6 million people were enrolled in Part A in 2009.

Front 13

PART B, the Supplementary Medical Insurance (SMI) program

Back 13

helps pay for physician, outpatient, home health, and preventive services. Part B is funded by general revenues and beneficiary premiums ($110.50 per month in 2010; $96.40 per month for beneficiaries held harmless from the premium increase – see page 5 for additional information). Beneficiaries who have higher annual incomes (over $85,000/individual, $170,000/couple) pay a higher, income-related monthly Part B premium; beginning in 2011, the health care reform law freezes the income thresholds at 2010 levels through 2019. In 2009, Part B accounted for 27 percent of total benefit spending.5 An estimated 42.4 million people were enrolled in Part B in 2009.

Front 14

PART C - the Medicare Advantage program

Back 14

allows beneficiaries to enroll in a private plan, such as a health maintenance organization, preferred provider organization, or private fee-for-service plan, as an alternative to the traditional fee-for-service program. These plans receive payments from Medicare to provide Medicare-covered benefits, including hospital and physician services, and in most cases, prescription drug benefits. Part C is not separately financed, and accounted for 24 percent of benefit spending in 2009. As of April 2010, 11.5 million beneficiaries are enrolled in Medicare Advantage plans.

Front 15

PART D, the outpatient prescription drug benefit,

Back 15

was established by the Medicare Modernization Act of 2003 (MMA) and launched in 2006. The benefit is delivered through private plans that contract with Medicare: either stand-alone prescription drug plans (PDPs) or Medicare Advantage prescription drug (MA- PD) plans. Individuals who sign up for a Part D plan generally pay a monthly premium; those with modest income and assets are eligible for assistance with premiums and cost-sharing amounts. The health care reform law establishes a new income-related Part D premium similar to the Part B premium, beginning in 2011, and gradually phases in coverage in the Part D coverage gap. Part D is funded by general revenues, beneficiary premiums, and state payments, and accounted for 10 percent of benefit spending in 2009. As of April 2010, 27.6 million beneficiaries are enrolled in a Part D plan.

Front 16

What is incrementalism

Back 16

Incrementalism is considered as “The Science of Muddling Through,” which indicated that public policy is developed through small changes to existing policies. It is effective or easier to make small changes to existing policies than to develop something entirely new because there will be never enough time for all the policy changes. For example The Social Security Act and The Older American Act are created through incrementalism since there are amendments being implemented which shaped both pieces of legislation to include important updates that enable the policies to address programs and services needed by the general population.

Front 17

What is blaming the victim? How does this relate to U.S. social policy?

Back 17

Blaming the victim is the notion that individuals are at fault for their shortcomings or their status in society, rather than considering the systemic or universal issues. It explains the inequity in our society, by suggesting that there are individuals who are inherently in a cycle of poverty, culturally deprived or career criminals due to their choice, rather than because of an inherent problem in society. Basically people in our society make negative decisions in their lives that influence their way of living. It relates to U.S. social policy because U.S. legislatives are based on the blaming the victim concept. For example, people with addictions and substance abuse histories are excluded from the country policies of their existing behavior.

Front 18

Who are elites? How do they influence policy?

Back 18

Elites are people who have access to opportunities that other groups may not have. With the opportunities given will allow them to gain ability and knowledge to influence public policy. Elite individuals may have been appointed to high-level policy making positions within our government or society. For example our President is considers as elite because he’s in the high position and could develop or change policies that will influence our society.

Front 19

What are street level bureaucrats? How do they influenc

Back 19

Street level bureaucrats are people who suggest that the implementation process should focus on what happens after policy is implemented. They have significant power and control over people’s lives, making decisions that affect who gets, what, how quickly, and under what circumstances.

Opinion: For example our first guest speaker is usually consider as street level bureaucrats because he works in a environment (social security services workforce) where he has tremendous role of shaping public services being offered to people (determining if a person is really eligible to receive government services or program)

Front 20

What does FPL stand?

Back 20

FPL- Federal Poverty Level

Front 21

or? What was the current level of the FPL for an individual?

Back 21

FPL's nationwide, one-size-fits-all amount of $10,830 per year.

Front 22

What is the Elder Economic Security Standard Index? How does it relate to the FPL?

Back 22

Elder Economic Security Standard Index- measure the income adequacy of older adults and it illustrates how costs of living vary geographically and are based on the characteristics of elder households: household size, homeownership or renter, mode of transportation, and health status. It relates to the Federal Poverty Level because in order to determine if the seniors are quality for public program services, they need to evaluate the income first, then base it to the Federal Poverty Level.
Elder Economic Security Standard Index (Elder Index), a tool that measures the actual costs of basic necessities for older adults. The Elder Index is quickly replacing federal poverty level (FPL) guidelines as a new standard for evaluating and meeting the needs of seniors across California.

Front 23

What do we know about how much older adults spend on healthcare (as a percentage of income)? How does this related to the Elder Economic Securiy Index?

Back 23

Since 1997 to 2006, health spending among Medicare beneficiaries has increased from 11.9% to 16.2%. So out of pocket spending for Medicare beneficiaries has increased by 33% in 10 years.

Front 24

What percentage of the U.S. population was 65+ in 2008?

Back 24

The percentage of the U.S. population was 65+ in 2008 is 12.8%

Front 25

By 2050, approximately how many millions of Americans will be over age 65?

Back 25

By 2050 there are approximately 88.5 or 89 millions of Americans will be over age 65.

Front 26

What age category is described as the “near old”? the “young old?”

Back 26

Near old is described as older adults ages 55 to 64 and young old are ages 65 to 74 years old.

Front 27

Which age category of people age 65+ is growing most quickly in the United States?

Back 27

85+ populations have rate of change increase by 188%.

Front 28

Which racial categories of people age 65+ is expected to grow the most quickly in the United States?

Back 28

Hispanic 224% and Asian American, Pacific Islander 199% increase.

Front 29

What is a sex ratio? How would you describe the changes of the sex ratio in people over age 65 in the U.S.?

Back 29

Sex ratio is the demographic concept that measures the proportion of males to females in a given population. It is usually measured as the number of males per 100 females. The changes of the sex ration in people over age 65 in the U.S. indicates that in 1900 men outnumbered women which is the sex ratio of 108.5 men: 100 women; however in 2000 women outnumbered men which is the sex ratio of 63.3 men: 100 women.

Front 30

What percentage of men over age 65 were single in 2008? What percentage of women?

Back 30

Men over age 65 were single in 2008- 4%.

Women over age 65 were single in 2008- 4%.
Basically, both men and women have the same percentage when it comes of single marital status.

Front 31

What percentage of men over age 65 were living alone in 2008? What percentage of women?

Back 31

Percentage of men over age 65 living alone in 2008 is 19%.
Percentage of women over age 65 living alone in 2008 is 36%.

Front 32

Approximately how many gay, lesbian, bisexual, transgender seniors are living in the US?

Back 32

1 to 3 million seniors gay, lesbian, bisexual, transgender seniors are living in the US.

Front 33

What has been the trend in the educational attainment of seniors in the U.S. between 1970 and 2008?

Back 33

Today the trend of educational attainment between 1970 and 2008 of older adults are increasingly more educated than the previous generation

-In 1970 there are 28% completed High School compared to 2008 there are 78.3%.
-In 2008, nearly 1 in 5 older adults completed a BA or more.

Front 34

What kind of growth can Santa Clara County expect between 1990 and 2020 (in terms of percentage of seniors)?

Back 34

The growth that Santa Clara County expects between 1900 and 2020 is 150-199.9% from the lecture Slides. However my personal notes says 155-190% growth.

Front 35

In California, which two racial categories will experience the largest amount of growth between 2005 and 2040?

Back 35

Hispanic Latino and Asian.

Front 36

What are the three most common causes of death among people age 65 and older in the U.S. today? How do these differ from the most common causes of death in 1900?

Back 36

Common causes of death in U.S. today for age 65 and older (Chronic Illness)
1. Heart Disease
2. Cancer
3. Stroke

Front 37

Common causes of death in 1900 (Infectious Diseases)

Back 37

1. Tuberculosis
2. Influenza
3. Pneumonia

Front 38

What is the most common chronic illness among people age 65 and older in the U.S.?

Back 38

1. Arthritis
2. Hypertension
3. Heart Disease
4. Hearing Loss
5. Cataracts
6. Orthopedic impairments

Front 39

What does ADL stand for? What are the five ADLs?

Back 39

ADL-Activities of Daily Living
Five ADLs-Eating, Bathing, Dressing, Transferring, and Toileting

Front 40

What does IADL stand for? What are some examples?

Back 40

ADL- Instrumental Activities of Daily Living

Examples: Meal preparation, Grocery/Household shopping, Money management, Medical management, Light and Heavy housework, Telephone use, and Cueing (for cognitive impairment)

Front 41

What does HICAP stand for?

Back 41

Health Insurance Counseling and Advocacy Program.

Front 42

Where is one place in Santa Clara County where you could recommend someone to go for HICAP?

Back 42

Council on Aging Silicon Valley.

Front 43

In what year was Medicare passed? Who was President?

Back 43

1965, Lyndon B. Johnson.

Front 44

What are the two largest population groups have access to Medicare?

Back 44

All people 65+ (39 million)
People with disability (8 million) - after 24 mos, they will be received Medicare

Front 45

What are two other groups of people who have access to Medicare?

Back 45

People with end-stage renal disease.
People with amyotrophic lateral sclerosis.

Front 46

How many months before turning 65 does one have to apply for Medicare?

Back 46

3 months.

Front 47

Medicare Part A

Back 47

Part A: Hospital Insurance - 45.6 mill enrollee in 2009:
Inpatient hospital care
Skilled nursing care
Home health care
Hospice care

Front 48

Part B: Medical Insurance

Back 48

Voluntary- 42.4 mill enrollee in 2009
Physician
Outpatient
Home health
Preventative services (HC Reform removed copays!)
Durable Medical Equipment

Front 49

Part C: Medicare Advantage

Back 49

plan 11.5 mill enrollee

Front 50

Q 11 Who was granted the ability to retire at 62 first - men, women, or they were granted at the same time?

Back 50

1956 - women could retire at 62 with reduced benefits

Front 51

Q13 At what age can someone born 1960 or after retire with full Social Security benefits? With partial (or reduced) Social Security benefits?

Back 51

1983 amendments

-born 1960 and later - retirement age increased from 65 to 67 years.
If retiring before 67, can begin collecting reduced Social Security benefits starting at 62

Front 52

Q14 What is the minimum of quarters that someone needs to work in order to qualify for Social Security retirement benefits?

Back 52

You can earn a maximum of four credits each year. Most people need 4 credits to qualify for benefits. The minimum is 40 quarters or 10 years.

Front 53

Q15 How many quarters of work can a person earn each calendar year? Approximately, how much would one have to earn in dollars to earn a quarter of work toward your Social Security retirement benefits?

Back 53

In 2011, you receive one credit for each $1,120 of earnings, up to the maximum of four credits per year.

Front 54

Q16 At minimum, how many years must a heterosexual couple need to be married in order for one partner to claim benefits as a divorced spouse?

Back 54

If you are divorced after at least 10 years of marriage, you can collect retirement benefits on your former spouse's Social Security record if you are at least age 62 and if your former spouse is entitled to or receiving benefits. If you remarry, you generally cannot collect benefits on your former spouse's record unless your later marriage ends (whether by death, divorce, or annulment).

Front 55

Q16 Women in which racial category are likely to be hurt by this policy? Why?

Back 55

A16 African American women has decreasing marital rates. By not being married, they did not receive any survivor’s insurance.

Front 56

Q17 Approximately how many millions of people receive Social Security benefits?

Back 56

59 million people

Front 57

Q18 For what percentage of seniors is Social Security the largest source of their income?

Back 57

80%

Front 58

Q18 For what percentage of seniors is Social Security the only source of their income?

Back 58

20%

Front 59

Where is one place in Santa Clara County where you could recommend someone to go for HICAP?

Back 59

Council on Aging Silicon Valley. CASV

Front 60

Q In what year was Medicare passed?
Who was President?

Back 60

1965 Lyndon B. Johnson

Front 61

Q What are the two largest population groups have access to Medicare?

Back 61

All people 65+ (39 million)
People with disability (8 million) - after 24 mos, they will be received Medicare.

Front 62

Q What are two other groups of people who have access to Medicare?

Back 62

People with end-stage renal disease.
People with amyotrophic lateral sclerosis.

Front 63

Q How many months before turning 65 does one have to apply for Medicare?

Back 63

3 months.

Front 64

What is a deductible?

Back 64

the amount of money which the beneficiaries must pay before the insurance company's own coverage plan begins

Front 65

Q What would happen if you did not work this amount of time, but wanted access to Part A?

Back 65

pay a premium
1. $248/mo between 30-39 quarters
2. $450/mo for less than 30 quarters

Front 66

Q What is the premium for Medicare Part B for most people in 2010?

Back 66

($96.40)
$110.50-$115.40 new enrollee
-People must pay extra if they delay enrollment
10% per 12 months
Not a one-time penalty, but paid for as long as in Part B

Front 67

Q At what level of income (single and married) does the premium for Part B increase?

Back 67

- $85,000 per individual
- $170,000 per couple

Front 68

Q What is the deductible for Medicare Part B?

Back 68

$162

Front 69

Q What is the coinsurance rate for Medicare Part B?

Back 69

20% coinsurance for most service

Front 70

Q What is Medicare Part C?

Back 70

Medicare Advantage plan
-Private health plans
HMO PPO PSO PFFS MSA SNP
- Generally pay for all benefits covered under Parts A, B, and D

Front 71

Q What is Medigap?

Back 71

Medicare Supplement Insurance. Sold by private insurance companies to help pay Medicare cost-sharing requirements and to fill gaps in the benefit package

Front 72

How many plans are there for Medigap?

Back 72

10 plans: Plan A-D,F,G,K-N
Starting June 1 2010, two new medigap plans, M and N, will be introduced, and insurers will no longer sell plans E, H, I and J. If you currently have a policy, even if it’s Plan E, H, I or J, you can keep it and your coverage won’t change.

Front 73

Q What was the policy that introduced Part D to Medicare?

Back 73

The Medicare Modernization Act 2003.

Front 74

Q In what year could beneficiaries get prescription drug coverage benefits?

Back 74

Medicare Part D is a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries in the United States. It was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and went into effect on January 1, 2006.

Front 75

Q Do beneficiaries pay a premium in Medicare Part D?

Back 75

yes, monthly premium

Front 76

Q What is the deductible in Medicare Part D?

Back 76

Annual deductible, no more than $ 310

Front 77

Q In what year was the first White House Conference on Aging?

Back 77

1961

Front 78

Q In what year was the Older Americans Act signed into legislation?

Back 78

1965

Front 79

Q What is the purpose of the Older Americans Act?

Back 79

Helps older adults at risk of institutionalization remain in their homes and communities

Front 80

Q In which federal department is the Administration on Aging housed?

Back 80

In the Department of Health and Human Services.

Front 81

Q Who is the current Assistant Secretary for Aging?

Back 81

Kathy Greenlee

Front 82

Q In what year were area agencies on aging established?

Back 82

1973

Front 83

How many AAAs are there today?

Back 83

650

Front 84

Q Who is the AAA for Santa Clara County?

Back 84

Stephen Schmoll, Executive Director- Council on Aging Silicon Valley.

Front 85

Q What is the purpose of the long-term care ombudsman program?

Back 85

1. Provides free and confidential services for residents of long-term care facilities and their families
2. Handles complaints
3. Represent their interests (individual and systemic advocacy)

Front 86

Q Who is the LTCOP for Santa Clara Country? (The Long Term Care Ombudsman Program)

Back 86

Catholic Charities of Santa Clara County

Front 87

Q What is the role of the National Family Caregiver Support Program?

Back 87

- Provides assistance to family caregivers
Adult family member or other individual who is an informal provider of in-home and community care to an older adult
- Services provided within five areas:
Information about available services
Assistance in gaining access to services
Counseling, organization of support groups, and caregiver training

Front 88

Q Respite care what is this?

Back 88

Supplemental services on a limited basis to augment care provided by caregivers

Front 89

How old is the National Family Caregiver Support Program?

Back 89

10 years

Front 90

Q In what year did the most recent amendments to the Older Americans take place?

Back 90

2006

Front 91

Q Title VI under the OAA provides services for what specific group?

Back 91

Older Native American

Front 92

What are ADRCs?
Aging and Disability Resource Centers

Back 92

ADRCs serve as single points of entry into the long-term care system for older adults and people with disabilities. Sometimes referred to as a one stop shops or "no wrong door" systems, single entry points address many of the frustrations consumers and their families experience.

Front 93

PDP and MA

Back 93

Individuals are eligible for prescription drug coverage under a Part D plan if they are entitled to benefits under Medicare Part A and/or enrolled in Part B. Beneficiaries can obtain the Part D drug benefit through two types of private plans: they can join a Prescription Drug Plan (PDP) for drug coverage only or they can join a Medicare Advantage plan (MA) that covers both medical services and prescription drugs (MA-PD)