Medicaid and Medicare Flashcards
(33 cards)
Who does Medicaid cover?
the low income population of the US
How is Medicaid financed?
both through the government and states (matching rates); collected through payroll taxes from working people
Entitlement program
means tested; based on income relative to the federal poverty level
Who covers nursing home costs?
Medicaid
Who have the highest Medicaid expenditures?
the disabled and blind populations
Federal Medicaid Assistance Program (FMAP)
how much the federal government matches spending the state; takes into account income per capita within states; minimum is 50% and max is 77%
Federal poverty line (FPL)
the line the government considers to be within poverty
Federal mandate
to receive federal funding states must cover certain populations
Who do states have to cover through Medicaid?
low income: pregnant people, children <6, children 6-18, parents and caretakers, people with disabilities, etc
What is Medicaid expansion?
states had the option to “opt in” to increase eligibility of adults, received 100% matching rate for newly covered population
Minimum eligibility standards for states who expanded Medicaid
138% for pregnant people, children, adults, and parents
Medically needy
too much money to qualify but spending significant money on medical care
Challenges of Medicaid
costs (long term care coverage is expensive), challenges to expansion in court
Maintenance of effort (MOE)
maintained Medicaid coverage for anyone on Medicaid while the public health emergency is in effect
SCHIP/CHIP
created in 1997, extends health insurance for children whose families earn too much to qualify for Medicaid but who cannot afford private insurance
Medicare
created in 1965, covers the population that is over 65, on disability payments, etc
Is Medicare means tested?
no
Dual eligible
people eligible for both Medicare and Medicaid, Medicare is the main form of insurance, automatically enrolled in Part D
What are the parts of Medicare?
Part A, Part B, Part C, Part D
Medicare Part A
covers inpatient hospital services, everyone is automatically enrolled in Part A
How is Medicare Part A financed?
Medicare payroll tax, no premiums but there are deductibles and coinsurance
Medicare Part B
covers physician expenditures and outpatient hospital costs, will not be enrolled in both B and C
How is Medicare Part B financed?
enrollee premiums and general government revenue from income taxes
What are the specific costs of Medicare Part B?
premium: $164.90 increase is income above $91k; deductible: $226; coinsurance: 20%
