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Gerontology M108 > Medicare/Medicaid > Flashcards

Flashcards in Medicare/Medicaid Deck (24):

eligibility criteria

factors that determine whether people can receive benefits from specific programs


age-based entitlement programs

programs that all adults are automatically entitled to receive benefits based on their age, not on their financial or health needs. Social Security and Medicare are examples.


universal and categorical benefits

age-based programs available as a social right to all persons belonging to a designated category, e.g., those over a certain age


needs-based programs

decide eligibility by financial need


selective benefits

determined on a case-by-case basis


contributary plans

older adults are entitled to these benefits based on their mandatory contributions into the system as a paid worker throughout their lives


discretionary funding (TANF)

Congress has to approve its funding annually and the amount varies from year to year

ex: TANF for low-income children and parents


graying of the federal budget

wide array of federal budget going to programs etc for the older population


retirement savings plan vs. safety net

social security used to be a safety net of financial support to help them survive since they didn't think to save for retirement or didn't think they would live that long or growing debt


social adequacy

shared societal obligation to provide a basic standard of living for all who are eligible, regardless of the size of their payroll contributions


individual equity

people receive benefits such as Social Security based on their earned right --payroll deductions


Social Security benefits

- frees middle generation from financial support to older relatives
- ensures compensatory income, regardless of age, to those who experience sudden income loss
- ensures basic protection for the neediest members of society regardless of age


long term care

long-term care
includes at home care, institutional care (nursing homes)
your needs can change over time high/low


acute care

active but short-term treatment for episode of injury or illness, urgent medical condition, or recovery from surgery
can just include a doctor's visit



social insurance system based on age available to all adults age 65+

federal funding

beneficiaries earn access by virtue of paying payroll taxes throughout the years of employment. it is intended to provide financial protection against the costs of acute or short-term care by hospitals and physicians

- Medicare reform: Medicare Part D, the Medicare Modernization, Improvement and Prescription and Drug Act


Medicare limitations

covers acute or short-term care but does not reimburse for long-term services and supports for older persons with chronic illness

- only covers about 47% of older adults' health care expenses


Medicare-funded home healthcare

only 4% of healthcare expenditures covered are for home healthcare -- must have a medical based need (cannot just be assistance with ADLs)

only for a short amount of time (injury etc)
"rehab center"



federal and state means-tested program
for poor and needy
don't need to pay into it

-- biggest payer of long term care (nursing home/"rehab center")



older adults covered by medicare and medicaid



elders only, acute care emphasis, some evolution, complicated/hard to navigate



any age, more social than health originally, limited long-term care emphasis, complicated/hard to navigate


Long-Term care Insurance

private long-term care insurance (LTC) aim to address gaps in home and skilled nursing care funding but do not cover all LTSS costs, EXPENSIVE



supplement insurance covers, medicare deductible and co-pays, items and services not covered by Medicare (hearing aids and eye glasses), charges exceeding amt approved by medicare


On Lok

first of models to integrate different sectors together into a single system of social care]]give support at home to people on the brink of nursing homes/rehab centers