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

3 views3 pages
Published on 2 Jan 2020
Course
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
wage)
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
government
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
Voluntary
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
Unlock document

This preview shows page 1 of the document.
Unlock all 3 pages and 3 million more documents.

Already have an account? Log in

Get OneClass Notes+

Unlimited access to class notes and textbook notes.

YearlyBest Value
75% OFF
$8 USD/m
Monthly
$30 USD/m
You will be charged $96 USD upfront and auto renewed at the end of each cycle. You may cancel anytime under Payment Settings. For more information, see our Terms and Privacy.
Payments are encrypted using 256-bit SSL. Powered by Stripe.