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22 Cards in this Set
- Front
- Back
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What are Medicare Benefits?
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Medicare insurance and its benefits are comprised of four parts, including:
Part A: Hospital Insurance Part B: Medical Insurance Part C: Medicare Advantage Plans Part D. Prescription Drug Coverage |
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Medicare Part D - deductible.
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If you join a Medicare prescription drug plan, you may have to pay up to the first $310 of your drug costs. This is known as the deductible.
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Medicare Part D - $2840 combined amount.
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During the initial coverage phase, you pay a copayment or coinsurance, and your Part D drug plan pays its share for each covered drug until your combined amount (including your deductible) reaches $2840.
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Medicare Part D - total $4550
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Once you and your Part D drug plan have spent $2,840 for covered drugs, you will be in the donut hole. Previously, you had to pay the full cost of your prescription drugs while in the donut hole. However, in 2011, you get a 50% discount on covered brand-name prescription medications. The donut hole continues until your total out-of-pocket cost reaches $4,550. This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts.
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The Affordable Care Act signed into law on March 23, 2010
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makes several changes to Medicare Part D to reduce your out-of-pocket costs when you reach the donut hole, including:
- In 2010, if you had expenses in the coverage gap, you should have received a $250 rebate from Medicare. - Beginning in 2011, if you reach the donut hole, you will be given a 50% discount on the total cost of brand name drugs while in the gap. - Medicare will phase in additional discounts on the cost of both brand name and generic drugs. |
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What kind of growth can Santa Clara County expect between 1990 and 2020 (in terms of percentage of seniors)?
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The growth that Santa Clara County expects between 1990 and 2020 is 150-199.9% from the lecture slides.
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Q1 Which country in the world had the first Social Security system? When?
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Germany - first social insurance program in 1880.
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Q2 When did the Social Security Act pass in the United States? Who was President at this time?
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1935. President Franklin D. Roosevelt
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Q3 In what two ways is Social Security a family program?
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1939 amendments added two new categories of benefits for:
1. dependents benefit for widows and minor children. 2. survivors benefits paid to the family in the event of the premature death of a covered worker. |
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Social Security's Old-Age, Survivors, and Disability Insurance (OASDI) - $106,800
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- limits the amount of earnings subject to taxation for a given year. The same annual limit also applies when those earnings are used in a benefit computation. This limit generally increases with increases in the national average wage index. We call this annual limit the contribution and benefit base, or taxable maximum. For earnings in 2011, this base is $106,800.
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Q5 How were African Americans excluded from Social Security when it was first introduced?
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In the beginning, SS covered only 60% of US workers. Excluded farm workers, a predominantly African American occupation.
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Q6 Who was the first person to receive Social Security? When? How old did this person live to be?
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Ida May Fuller on Jan. 31 1940. 100 years old.
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Q7 What are two examples of expansions of citizenship in the form of benefits in the context of Social Security?
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1936 - Spouses and chidren of workers (premature death) and Survivor’s insurance
1950 - Benefits expanded to match inflation 1956 - Women could retire at 62 with reduced benefits 1961 - Men could retire at 62 with reduced benefits |
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Q8 What are two examples of restrictions/contractions of citizenship in the form of benefits in the context of Social Security?
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Changes preventing people from accessing benefits
1980 - 1983 = Continuing disability reviews 1983 amendments = Increased age of retirement from 65 to 67 1996 = People with alcohol and drug addiction no longer qualified for SSDI (Social Security Disability) or SSI (means tested) |
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Medicare Part A
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Part A: Hospital Insurance - 45.6 mill enrollee in 2009:
Inpatient hospital care Skilled nursing care Home health care Hospice care |
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Part B: Medical Insurance
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Voluntary- 42.4 mill enrollee in 2009
Physician Outpatient Home health Preventative services (HC Reform removed copays!) Durable Medical Equipment -- Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment) $155.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $155.00 deductible.) |
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Part C: Medicare Advantage
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A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
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What Is Part D (Medicare Prescription Drug Coverage)?
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There are two ways to get Medicare prescription drug coverage:
1. Medicare Prescription Drug Plans. These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans. 2. Medicare Advantage Plans (like an HMO or PPO) are other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs." |
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Medicare Advantage Plan
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If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
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Different Types of Medicare Advantage Plans
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-Health Maintenance Organization (HMO) Plans
-Preferred Provider Organization (PPO) Plans -Private Fee-for-Service (PFFS) Plans -Special Needs Plans (SNP) |
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There are other less common types of Medicare Advantage Plans that may be available:
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-HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.
-Medical Savings Account (MSA) Plans—A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. |
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What Does a Medicare Advantage Plan Cover?
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Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
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