History of Medicare

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History of Medicare

• 1948 ? Harry Truman
• 1950 Social Security officials ? realized older
  Americans were facing a health care crisis.
• 1950-1963 population grew 12 million to 17.5
  million.
• Costs rising 6.7 percent a year
• 1963 ? Five big states
• 32 percent of population took up 90 percent of
  federal funds.

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History of Medicare Continued

• 1965 ? Lyndon B. Johnson
• House and Senate passed the Medicare bill
• 1972 ? Medicare eligibility was extended

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Medicare Overview

• The centers for Medicare and Medicaid Services
  administer Medicare
• Medicare Two Parts
• Part A ? Hospital Insurance (HI)
• Part B ? Supplementary Medical Insurance (SMI)

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Medicare OverviewPart A

• Hospital Insurance helps pay?
• 1. Inpatient hospital care covers 90 days of
  impatient hospital services in each benefit
  period plus an additional 60 lifetime reserve
  days
• 840 deductible for first day
• Past 60 days 210 per day for days 61-90
• Past 91st day 150th day 420 per day
  co-payment

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Medicare Overview Part A Continued

• 2. Care in a skilled nursing facility for
  each benefit period if all Medicare requirements
  are met
• Covered up to 100 days
• Pays in full for the first 20 days
• In 2003 mandatory co-payment of 105 for days
  21-100

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Medicare Overview Part A Continued

• 3. Home Health Services covered up to 100
  visits per spell of illness following a hospital
  stay.
• Requirements
• Patient is homebound
• A need for intermittent skilled nursing or
  therapy services exists.
• Services are provided by a Medicare certified
  home health agency.

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Medicare Overview Part A Continued

• 4. Hospice Care keep the patient as
  comfortable as possible
• No treatment provided
• Part A ? Free if you qualify
• Exception Voluntary enrollees

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Medicare Overview Part B

• Supplementary Medical Insurance helps pay for ?
• Doctors
• Outpatient hospital care
• Occupational and physical therapy
• Laboratory tests and X-rays
• Durable medical equipment

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Medicare Overview Part B Continued

• Part B coverage is voluntary
• Monthly premium 66.60
• Additional costs ? 100 deductible
• 20 percent coinsurance payment
• Excess charges
• Some outpatient services

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Medicare Overview Part B Continued

• What Part B doesnt cover ?
• Eyeglasses
• Outpatient prescription drugs
• Hearing aids
• Dental care

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Medicare Eligibility

• Part A Hospital Insurance
• If you are at least 65 years old
• You or your spouse worked at least 10 years in
  Medicare covered employment
• You are a citizen or permanent resident of the
  United States

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Medicare Eligibility Continued

• Part A Contd
• Premium Free at age 65
• Already receiving retirement benefits from Social
  Security or the Railroad Retirement Board
• Are eligible to receive Social Security or
  Railroad benefits but have not yet filed
• Your spouse had Medicare covered government
  employment

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Medicare Eligibility Continued

• Part A Contd
• Under 65 without paying premiums
• Have received Social Security or Railroad
  Retirement Board Disability Benefit for 24 months
• Are a kidney dialysis or kidney transplant
  patient

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Medicare Eligibility Continued

• Part A Contd
• State Programs that pay premiums for you
• Must have part A
• Have assets, such as bank accts, stocks, and
  bonds that are not more than 4,000 for single
  person or 6,000 for couples
• Have a monthly income that is below certain limits

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Medicare Eligibility Continued

• Part B Medical Insurance
• All the eligible candidates for Part A are
  eligible for part B
• must be purchased additionally

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United States Population

• Demographics
• Median age 35.3 in 2000 opposed to 32.9 in 1990
• Population from 45-54 swelled 49 percent from
  1990-2000
• Pop. From 65-74 rose from 31.2 to 35 million
  since the 1990 census to the 2000 census

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Options under Medicare

• Medigap Insurance
• Medicare Select
• MedicareChoice

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Medigap Insurance

• What is it?
• Medigap is insurance to help cover gaps in
  Medicare.
• A J Standardized Plans
• Benefits covered in one plan are the same
  regardless of which carrier offers it.

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Medigap Plans
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Medicare Select

• What is it?
• Same as Medigap insurance, however stipule
  involved.
• Differences with Medigap
• Requires you to use their network of providers.

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MedicareChoice Plans

• HMOs
• PPOs
• PSOs
• PFFS

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Medicare Modernization Act of 2003

• 1st Medicare approved drug discount cards
• 2nd Medicare Advantage
• 3rd New and improved preventive benefits
• 4th Prescription drug benefit

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Issues with Medicare

• Projected to be bankrupt in 2026
• A problem caused by paying out more money then
  how much is receiving.
• Savings are being eroded by increasing prices

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Politics

• Suppressed the numbers
• Fuel for the democratic party
• John Kerry
• Major problems occurring

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Social Security Administration (SSA)

• Currently 2.7 percent of GDP is the cost of
  Medicare
• In 2078 Medicare costs projected to reach 14
  percent of GDP
• Strains on Medicare
• Medicare Modernization Act of 2003
• Increasing costs of healthcare
• Low tax income and high expenditures

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Recommendations

• Prescription costs
• Modifications to Modernization Act

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US Prescription Drug Prices vs. Canadians Prices

• Lipitor
• United States 272 - 308
• Canada 159 - 199
• Zocor
• United States 372 - 451
• Canada 198 - 224

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US Prescription Drug Prices vs. Canadians Prices
Continued

• Celebrex
• United States 145 - 177
• Canada 63 - 71