IPE 350 - Spring 2012 Funding health care STUDENT

IPE 350 - Spring 2012 Funding health care STUDENT - Funding...

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Funding Health Care Anthony Breitbach PhD, ATC IPE 350
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Financing Healthcare Direct Pay: self-pay or out of pocket expenses Insurance: either through an employer or through self-insurance Government: based on criteria of need Medicare Medicaid
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Who Pays for Health Care Expenditures? Private funds pay for about 55 percent of total health care spending. Government Plans Medicare Medicaid State Children's Health Insurance Program (SCHIP) Self-Pay
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Distribution of Personal Health Care Expenditures by Source of Payment, 1999 and 2009 Notes: Personal health care expenditures are spending for health care services, excluding administration and net cost of insurance, public health activity, research, and structures and equipment. Out-of-pocket health insurance premiums paid by individuals are not included in Consumer Out-of-Pocket; they are counted as part of Private Health Insurance. Medicaid spending for the State Children's Health Insurance Program (which began in 1998) is included in Other Government Programs, not in Medicaid. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2009; file nhe2009.zip). 2009 Public 47.4% Private 52.6% 1999 Public 42.6% Private 57.4% $1.1 Trillion $2.1 Trillion
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Medicare and Medicaid Amendments to Social Security Act Title 18 Medicare Helps to provide health care for those over 65 and designated as permanently disabled if under 65 and later those with end-stage renal disease and ALS Title 19 Medicaid Helps to provide health care for the poor Administered by Centers for Medicare & Medicaid Services (CMS)
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Medicare Part A Covered services are How is the premium covered? What are the costs to the beneficiary?
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Medicare Part B Covered services are How is the premium covered? What are the costs to the beneficiary?
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Medicare Advantage (Part C) Allows Medicare recipient to join HMO
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Medicare Part D Covered services are How is the premium covered? What are the costs to the beneficiary?
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Medicare Administered by the Federal Government Medicare Part A inpatient hospital and nursing home care home health and hospice care Medicare Part B voluntary insurance program to supplement the cost not covered under Part A physician’s fee for service and other outpatient services
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Contemporary Changes to Medicare Medicare Part C – Medicare Advantage Enroll in private plan – HMO, PPO, fee-for-service Not separately financed (funds come out of Part A and B ) Medicare Part D – Prescription drugs Provided through private contracts with Medicare Financed by premiums, federal revenues, and state payments (those also eligible for Medicaid)
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Medigap policies Private insurance in addition to Medicare to cover deductibles and co-payments
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How is Medicaid funded? How is Medicaid administered?
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IPE 350 - Spring 2012 Funding health care STUDENT - Funding...

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