POL 321 Lecture Notes - Lecture 14: Co-Insurance, Hearing Aid, Political Movement

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Published on 2 Jan 2020
Lecture 14
Government Healthcare Programs
Majority of people in the US get insurance from employer, but there are other sources
o Medicare ~17%
o Medicaid ~20%
o VA
o Uninsured 8-9%
In 1950s, many people of working age & employed status have health insurance, but leaves
out the elderly & the low-income/poor (unemployed, work part-time, work minimum
o Political movement for policy solutions for these vulnerable people
High rates charged by private market for elderly coverage
1965 Social Security Act Amendmentssigned by President Johnson to create Medicare
& Medicaid
Medicarecoverage for the elderly, administered & payed for entirely by the federal
o About 15% of total federal budget
o Funding comes from payroll taxes (~1/4) & rest from the general fund & premiums
o Premium is determined by income on a sliding scale
o 4 Parts: A, B, C, D
o Part Ahospital care, hospice, & home health
If you (or spouse) pay payroll taxes 10 years, eligible as long as 65+
No premiums, ~$1300 deductible
o Part Bphysician care, outpatient, tests, equipment
Has premiums ~$135-$460/month by income
Required unless you have other coverage if 65+, or incur penalties
Low deductible, then 20% coinsurance
o Part Cmanaged care plans
Optionally choose to get traditional private coverage that the federal
government makes payments to
Costs additional premium but tends to cover extra things like dental & optical
About 1/3rd Medicare enrollees get it
o Part Dprescription drugs
Administered by private companies approved by the federal government
o Medicare doesn’t cover eyeglasses, hearing aids, or long-term care (like assisted
living facilities)
o May need to pay out of pocked, get extra coverage, or get Medicaid (if eligible) to
help with these other services
o Reimbursement is the actual cost of providing the service plus some overhead,
salaries, administrative costs
o Clear reimbursement rates set by federal government law
o Doctors aren't required to see/take/accept Medicare
Get paid less so may choose not to
Many still do though since higher degree of confidence that bill will be paid
Medicaidcoverage for the poor, especially families & pregnant women
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