4 AHS Medicare and Medicaid fall 2018.pptm

4 AHS Medicare and Medicaid fall 2018.pptm - The American...

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1 Government Funded Healthcare: Medicare & Medicaid The American Healthcare System
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2 Today’s Topics 1. Medicare Medicare Overview What Does it Cover? Characteristics of Medicare Beneficiaries How Much Does it Cost? 2. Medicaid History of Medicaid Characteristics of Medicaid Beneficiaries Future of Medicaid
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3 President Lyndon Johnson Signing Medicare and Medicaid into Law July 30, 1965
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4 Medicare and Medicaid Both are federally supported programs enacted in 1965 to provide healthcare coverage to vulnerable populations. The services provided under each program are mandated by the federal government, i.e. feds decide what gets covered. Medicare Provides services to elderly (over 65) and disabled, ESRD, ALS Medicare is funded totally by federal government + beneficiaries Medicaid Provides services to the poor Cost is shared between federal government and the individual states
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5
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Total Health Services & Supplies $2,469 Billion Physicians $587 Billion Prescription Drugs $271 Billion 17% 17% 9% 30% 8% 22% 26% 22% 22% 28% 39% 43% 31% 52% 35% combined Medicare Medicaid NOTE: Includes neither spending on CHIP nor administrative spending. Definition of nursing facility care was revised from previous years and no longer includes residential care facilities for mental retardation, mental health or substance abuse. The nursing facility category includes continuing care retirement communities. SOURCE: CMS, Office of the Actuary, National Health Statistics Group, National Health Expenditure Accounts, 2015. Data for 2013. Medicare and Medicaid Pay for Nearly 40% of Total Health Care Spending Nationwide
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7 Medicare
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8 Medicare Overview Enacted in 1965 as Title 18 of the SSA to provide health coverage for seniors. Expanded in 1972 to cover younger beneficiaries with permanent disabilities. Covers individuals without regard to income or medical history. Today covers 59 million beneficiaries, including 46 million seniors and 9 million younger adults with permanent disabilities. Median age of Medicare beneficiaries is 73 and 12% are over 85. Cost the federal government $646 billion in 2015, representing 16% of the Federal budget and 21% of total national healthcare spending. Has four parts: A, B, C, and D
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9 Medicare Overview 1. Part A: Hospital Insurance. Funded by dedicated tax of 2.9% on earnings paid by employers and employees (1.45% each, increasing to 2.35% in 2013). Individuals are entitled to part A if they or their spouse have contributed to payroll taxes for 10 years or more. Part A covers: inpatient hospital care skilled nursing facility hospice care limited home health services 2. Part B: Supplemental Medical Insurance. Funded by beneficiary premiums and general revenues. Individuals receiving social security at age 65 are automatically enrolled unless they opt out. Part B covers: physician services outpatient hospital care select preventive and diagnostic services mental health home health visits
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10 Medicare Overview 3.
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  • Fall '16
  • ForneyFleming
  • Centers for Medicare and Medicaid Services

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