Module 7 lecture, part 4

Question 1

What is Medicare part C?

Answer 1

Medicare advantage

Question 2

Hx of Medicare part C

Answer 2

Began as Medicare + Choice in 1997 then renamed Medicare Advantage in 2003
-No additional svcs, but additional health plan choices
-To channel into managed care for Parts A and B
-Can choose to remain in original Medicare program

Question 3

Aspects of Medicare part C

Answer 3

Pay additional premiums
Additional benefits
No need for Medigap
Lower out of pocket costs

Question 4

What aimed to reduce payments to Medicare Advantage plans?

Answer 4

The ACA

Question 5

What is Medicare part D?

Answer 5

Prescription drug coverage

Question 6

When was Medicare part D implemented?

Answer 6

2006

Question 7

What can enrollees choose between for Medicare part D?

Answer 7

Stand-alone plans for prescriptions only
Part C (all svcs through managed care)

Question 8

Payment in Medicare part D

Answer 8

Requires payment of a deductible

Question 9

Three levels of out-of-pocket costs after deductible in Medicare part D

Answer 9

Basic level
Coverage gap (doughnut hole)
Catastrophic level

Question 10

What is another component of part D, that’s also a component of part B?

Answer 10

Higher income leads to paying more, IRMAA

Question 11

What was eliminated by 2020 in terms of Medicare part D?

Answer 11

Coverage gap by the ACA

Question 12

Aspects of Medicare out of pocket costs

Answer 12

Relatively high deductibles, copayments, and premiums
No eyeglasses, dental, long-term care coverage
No limit on out of pocket expenses in the original Medicare program
-Exception: a half of the Medicare Advantage plans have cost sharing limits
-A typical beneficiary spends about 20% of income on out of pocket costs

Question 13

What fraction of national healthcare expenditures is consumed by Medicare?

Answer 13

1/5

Question 14

Trends of heath insurance and supplemental Medicare insurance in 2012

Answer 14

Deficits

Question 15

What is the future of Medicare?

Answer 15

Headed for insolvency unless it is steered around

Question 16

What are the 3 main factors threatening future solvency of Medicare?

Answer 16

Rising cost of delivery HC
An aging population
Shrinking workforce to support tax revenues and smaller age increase than medical inflation

Question 17

What constituted 80% of Medicare financing?

Answer 17

Payroll and general tax combined

Question 18

Under what legislation is Medicaid?

Answer 18

Title XIX of the SSA

Question 19

Who does Medicaid finance?

Answer 19

Indigent as determined by each state (means tested)

Question 20

Who finances Medicaid?

Answer 20

Jointly financed by federal and state gov’ts

Question 21

Who are dual eligible beneficiaries?

Answer 21

Eligible for both Medicare and Medicaid

Question 22

Full duals for Medicare and Medicaid

Answer 22

Qualified for all benefits under both Medicare and Medicaid

Question 23

Partial duals for Medicare and Medicaid

Answer 23

Some of the costs paid by Medicaid

Question 24

What occurred in terms of Medicaid and the ACA?

Answer 24

Mandates got struck down by the Supreme Court
-Gave states a choice to either expand or not expand their Medicaid programs to 138% of the federal poverty level without penalty from the federal gov’t
Uncertain coverage and benefits for many low-income ppl

Question 25

What were the 2 ironies of the Medicaid ACA strikedown?

Answer 25

Non-complying states don’t have to use the assets test to determine eligibility, resulting in that a millionaire can qualify for Medicaid based solely on low income
Preventive svcs at the states’ discretion for existing beneficiaries leads to inconsistent preventive svcs for Medicaid enrollees in the same state