Health Care for Older Adults Pat Mezinskis April, 2008.

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Presentation transcript:

Health Care for Older Adults Pat Mezinskis April, 2008

Health Insurance for Older Adults Older Americans Act of 1965: made funds available for the elderly Social Security Act of 1935: amended in 1965 to provide Medicare and Medicaid

Medicare (Title XVIII) Federal health insurance program established for those over 65 Today it also includes some people with disabling diseases such as End Stage Renal Disease

Medicare (Title XVIII) Payment is based on DRGs which is a prospective method of deciding costs rather than a retrospective method

Medicare (traditional) Part A: funded through SS payroll taxes Covers: hospital services blood transfusions SNF (3 months or less) home health care hospice care inpatient psychiatric care

Medicare (traditional) Part B: monthly premiums $93.50 for 2007 Covers: MD/nurse practitioner services outpatient services emergency services PT/OT/ST outpatient psychiatric services

Medicare (traditional) Part B Covers: lab fees ambulance inpatient drugs

Medicare (traditional) Part B Now covers some preventive services: mammography, prostate screening, glaucoma screening, bone density measurements, diabetes ed., colorectal cancer screening, pap smears, some vaccinations

Medicare Home Care Benefit Provides acute or restorative skilled nursing care Intermittent or short-term basis For homebound patients under care of a physician

Medicare Not covered: Long-term nursing home care Routine physicals Dental care Eye exams, glasses Hearing exams, hearing aids

Managed Medicare Part C- “Medicare Advantage” Must provide all that Medicare does Provides preventive care

Medicare Part D 2006-NEW Prescription Drug Benefit Optional

Medicaid (Title XIX) Assistance for the poor, uninsured “Means” tested- must be indigent to qualify Assets and income must not exceed your state’s defined poverty level Look-back period currently 3 years

Medicaid Covers: Inpatient and outpatient hospital care Lab and x-ray services Physician services Skilled nursing home care

Other Programs Ohio Passport Elderly Services Program (ESP) Supplemental Medigap LTC insurance

Cost of Health Care Home Care- $15-30/hour Home Nursing Care- $35-75/hour Adult Day Service-$40-100/day Assisted Living-$ /day Nursing Home Care-$ /day

Health Care Levels Independent Living Assisted Living Skilled Nursing Care Traditional nursing home Eden Alternative Green Houses Dementia Care or Memory Unit

Health Care Regulations Nursing homes-licensed Medicare/Medicaid facilities-licensed and certified Highly regulated industry Only so many beds available in state

Housing Options Life Care or Continuing Care Retirement Communities (CCRC) Foster Care Homesharing Assisted Living Facility Co Housing

Community Resources Senior Centers Adult Day Care Respite Care Hospice Meals-on-Wheels