PHSC 2 Lecture Notes - Lecture 8: Medicare Advantage, Co-Insurance, Copayment
Document Summary
Title xvii of social security amendments of 1965. > 65 years of age, disabled, end stage kidney disease, als. Federal tax on wages during working year. Hospital, nursing home, home health (followed by hospital stay) & hospice. Doctor or other outpatient, preventative care, home health not associated with hospital stay, ambulance, lab & diagnostic radiology, outpatient mental health. Small deductible - some co-payment & co-insurance. Combine a&b benefit paid by medicare to qualifying hmo or ppo - hmo/ppo charge small premium, co-pay & co-insurance. Exclusion - dental, vision, or hearing (unless associated with medical condition) & nursing homecare up to 100 days. Either private insurance or medicaid (if income qualified) Excludes rx, purchase a separate part d plan for rx. Only 14% of total federal budget but 20% of national health expenditures. Sets national standard for way services are priced. Private insurance uses medicare as starting point for price negotiations. New initiatives in chronic disease management (diabetes, high blood pressure)