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Medicare Unit 7

Medicare Unit 7. Medicare Part A Payment Plan Beneficiary Pays (2009). Hospital Stays 1-60 days $1068 61-90 days $267/day 91-150 days $534/day 151+ days all costs Monthly premium $244. SNF 1-20 days nothing 21-100 days $133.50 per day max 101+ days all costs

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Medicare Unit 7

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  1. MedicareUnit 7

  2. Medicare Part A Payment PlanBeneficiary Pays (2009) Hospital Stays 1-60 days $1068 61-90 days $267/day 91-150 days $534/day 151+ days all costs Monthly premium $244 SNF 1-20 days nothing 21-100 days $133.50 per day max 101+ days all costs Annual deductible $1,068

  3. Medicare Part A Payment PlanBeneficiary Pays Home Health Care Nothing for approved home health care services 20% of approved durable medical equipment Hospice Co-payment of $5 for prescription drugs 5% of Medicare-approved amount for respite care

  4. Medicare Part BBeneficiary Pays Medical & Other $135 deductible $96.40 per mo. premium 20% of Medicare approved physician cost 20% outpatient physical, occupational, & speech-language therapy 50% outpatient mental health care Home Health Care Nothing for Medicare-approved services 20% of Medicare-approved durable medical equipment Premium higher for singles with incomes of $85,000 + & incomes of $170,00 +

  5. Medicare Part BBeneficiary Pays Clinical Lab Services Nothing for Medicare-approved services Outpatient Hospital Services 20% of billed amount after deductible

  6. Other Part B Coverage • Insurance Company incentive - $12 billion in subsidies to private insurers that offer health plans to Medicare beneficiaries. • Beginning 2010 Medicare will face competition among private insurance plans. • Medicare savings accounts – tax shelters for individuals with deductibles above $1,000 for singles & $2,000 for couples.

  7. Prescription Drug Benefit (2009) • Premium - $450/yr • Deductible - $250 • Coverage – 75% of drug costs up to $250; 25% $259 - $2,250 • Gap – no coverage between $2,250 – $5,100 • After $5,100 Medicare pays drug costs • Low-income subsidies – premium, deductible, & coverage gap waived for those at 135% FPL & lower ($22,588 for couples) & have less than $6,000 liquid assets • Company incentive – tax-free subsidies to employers who maintain to insurance companies

  8. Medicare Advantage + Choice Plans Beneficiary Pays Part A Same payments Part B $58.70/mo. premium + additional Choice Plan’s premium (?) Choice Plan’s co-payments for services

  9. “Accepting Assignment”Payment to Physician

  10. Example of Accepting Assignment

  11. Medicaid • Monthly income of $1,737 for single • Spend down to $2,000 liquid assets for institutionalized spouse • Entire SSI goes to pay for institutionalization • Community spouse can have between $95,100 in assets • Maximum monthly income $1,737 • Window – 3 yrs from date of institutionalization or 5 yrs for transfers to trust

  12. Main Problems in Providing Care for Elderly • Limited coverage under Medicare −homebound status −skilled nursing • 1.4% or $13/mo increase in SSI – 1/3 of this will go for increase in Medicare premiums • Private insurance option at cost to elderly • Cost of home health care services expensive • Cost of long-term care expensive • Problems with managed care plans

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