5. 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.

6. History of Medicare Continued 1965  Lyndon B. Johnson House and Senate passed the Medicare bill 1972  Medicare eligibility was extended

7. 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)

8. Medicare Overview Part A Hospital Insurance helps pay  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 91 st day – 150 th day = $420 per day co- payment

9. 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

10. 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.

11. 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

12. Medicare Overview Part B Supplementary Medical Insurance helps pay for  Supplementary Medical Insurance helps pay for  Doctors Outpatient hospital care Occupational and physical therapy Laboratory tests and X-rays Durable medical equipment

13. Medicare Overview Part B Continued… Part B coverage is voluntary Part B coverage is voluntary Monthly premium = $66.60 Additional costs Additional costs  $100 deductible  20 percent coinsurance payment  Excess charges  Some outpatient services

14. Medicare Overview Part B Continued… What Part B doesn’t cover What Part B doesn’t cover  Eyeglasses Outpatient prescription drugs Hearing aids Dental care

15. 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

16. Medicare Eligibility Continued… Part A Cont’d 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

17. Medicare Eligibility Continued… Part A Cont’d 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

18. Medicare Eligibility Continued… Part A Cont’d 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

19. Medicare Eligibility Continued… Part B Medical Insurance All the eligible candidates for Part A are eligible for part B must be purchased additionally

20. 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

21. Options under Medicare Medigap Insurance Medicare Select Medicare+Choice

22. 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.

23. Medigap Plans

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

25. Medicare+Choice Plans HMOs PPOs PSOs PFFS

27. Medicare Modernization Act of 2003 1 st = Medicare approved drug discount cards 2 nd = Medicare Advantage 3 rd = New and improved preventive benefits 4 th = Prescription drug benefit

28. 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

29. Politics Suppressed the numbers Fuel for the democratic party John Kerry Major problems occurring

30. 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

31. Recommendations Prescription costs Modifications to Modernization Act

32. US Prescription Drug Prices vs. Canadian’s Prices Lipitor United States = $272 - $308 Canada = $159 - $199 Zocor United States = $372 - $451 Canada = $198 - $224

33. US Prescription Drug Prices vs. Canadian’s Prices Continued… Celebrex United States = $145 - $177 Canada = $63 - $71