Class 7 Medicare Ellen Andrews, PhD PCH 358 SCSU Spring 2018 If - - PowerPoint PPT Presentation

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Class 7 Medicare Ellen Andrews, PhD PCH 358 SCSU Spring 2018 If - - PowerPoint PPT Presentation

Oct 09, 2023 160 likes •443 views

Class 7 Medicare Ellen Andrews, PhD PCH 358 SCSU Spring 2018 If you only get one thing . . . Medicare Medicaid Run by federal government Run by states Funded only by federal Funded jointly by states and government feds Covers

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Ellen Andrews, PhD

PCH 358 SCSU Spring 2018

Class 7 – Medicare

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If you only get one thing . . .

Medicare Medicaid Run by federal government Run by states Funded only by federal government Funded jointly by states and feds Covers seniors, people with disabilities Historically covers children, parents, low-income seniors, people with disabilities Now states can cover low income adults without children No income exclusion Income qualifications Coverage set by fed.s Coverage set by states

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History of Medicare and Medicaid

  • Video

– Kaiser Family Foundation – http://kff.org/medicaid/video/medicare-and- medicaid-at-40/

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What is Medicare?

  • Second largest US coverage program

– 54.1 million Americans (2016) – 605,000 in Connecticut – 17% of total US population, 17.2% of CT population

  • 69% fee for service, 31% in managed care plans

– 25% managed care in CT

  • Mainly seniors over age 65, people with disabilities

– CT 87% aged, 13% disabled

  • All income levels, but 28% are below 200% FPL in

CT

  • Run by federal government alone
  • Single payer system
  • Very popular, especially with beneficiaries
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What is Medicare?

  • Medicare is the reason that only 0.7% of CT

seniors are uninsured, vs. 4.9% of all CT residents

  • Most people over age 65 are automatically

eligible for Part A, free

  • Covers citizens and legal residents
  • No pre-existing condition exclusion, eligible

regardless of medical history

  • Doesn’t cover dental, hearing or vision care
  • Limited care for inpatient and nursing home

care

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What is Medicare?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

<100% FPL 100-199% FPL 200-399% FPL 400+% FPL White Black Hispanic Male Female

CT Medicare beneficiaries

2015

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Medicare costs per person

$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000

US CT

Medicare spending per person

2015

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20.4 24.9 28.4 31.1 34.3 37.6 39.7 42.6 47.7 55.6 64.3 73.5 81.5 86.5

1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035

SOURCE: 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

Medicare Enrollment, 1970-2035

Historical Projected

In millions:

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50% 50% 40% 27% 23% 20% 17% 15% 13% 5%

NOTE: ADL is activity of daily living. SOURCE: Urban Institute and Kaiser Family Foundation analysis, 2012; Kaiser Family Foundation analysis of the Centers for Medicare & Medicaid Services Medicare Current Beneficiary 2009 Cost and Use file.

Characteristics of the Medicare Population

Percent of total Medicare population: Income below $22,502 Savings below $77,482 3+ Chronic Conditions Fair/Poor Health Cognitive/Mental Impairment Dually Eligible for Medicare and Medicaid Under-65 Disabled 2+ ADL Limitations Age 85+ Long-term Care Facility Resident

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NOTES: Question wording varied slightly in 2004-2006 surveys. Neither/neutral (VOL.) and Don’t know/Refused answers not shown.

SOURCE: Kaiser Family Foundation surveys

Seven Years Later, Medicare Part D Popular Among Seniors

17 24 24 27 25 21 32 31 28 23 30 32 42 63% 55 47 45 44 42 34 32 37 50 45 46 30 34 14%

0% 20% 40% 60% 80% Feb Apr Jun Oct Dec Apr Aug Oct Dec Feb Apr Jun Nov Nov 2004 2005 2006 200720082009201020112012 2013

Favorable Unfavorable AMONG THOSE AGES 65+: As you may know, Medicare provides a prescription drug benefit, known as Medicare Part D. Given what you know about it, in general, do you have a favorable or unfavorable impression

  • f the Medicare prescription drug benefit?
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Parts of Medicare

Parts Covers Medicare Part A Inpatient hospital, skilled nursing facility, some home health, hospice Medicare Part B Physician services, tests, outpatient surgery, some home health, DME,

  • ne-time “Welcome to Medicare”

physical Medicare Part C Medicare Advantage -- managed care plans Medicare Part D Prescription drug coverage

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Medicare Part A

  • Hospital coverage
  • No premiums for most people
  • $1,316 deductible
  • Coinsurance for each hospital stay over

60 days

  • Hospital coverage limited to 150 days,

$329 and up daily costs after 60 days

  • Skilled nursing facility covered up to

100 days, daily costs after 20 days

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Medicare Part B

  • Outpatient care coverage
  • Voluntary, but automatic enrollment
  • 95% of Part A beneficiaries enroll
  • Premiums $109/month, more for higher incomes,

deducted from Social Security check

  • Premiums rise annually based on program costs
  • $183 deductible
  • Then 20% coinsurance
  • Covers most outpatient care
  • 86 % of US beneficiaries have supplemental

insurance to cover their costs

  • Through retirement benefits, purchase themselves –

Medigap plans, Medicare Advantage, Medicaid

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Medicare Part C

  • Medicare Advantage - managed care plans
  • Insurer gets a set amount per person, covers medical

costs = Financial Risk

  • Voluntary, can switch back to fee for service annually
  • 31% of beneficiaries US, 25% in CT
  • Offer lower cost sharing, lower premiums and/or extra

benefits, most include prescription drug coverage

  • Eligible for Part C if eligible for Parts A and B
  • Have enrolled healthier members
  • Pre-ACA plans were paid 14% more than those members

would have cost in fee for service

  • Lowering rate of increase to Medicare Advantage plans is

funding national health reform costs

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Medicare Part D

  • Prescription coverage
  • Available to anyone eligible for Parts A and B
  • Voluntary
  • 51% of CT beneficiaries have Part D drug coverage
  • Added in 2006
  • Through private plans, 26 choices in CT
  • Premiums vary by plan and across the country
  • CT average $52.73/month + for higher incomes
  • US average $54.16/month
  • Standard benefit
  • Seniors still paying premiums while in donut hole
  • Under ACA, donut hole phases out by 2020
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Access to care

  • Pretty good
  • Only 6% of beneficiaries report any problems accessing

care

  • Pays 20% of all US health care bills (2008)
  • 29% of all hospital bills
  • Pays 21% of all physician bills
  • Pays 41% of all home health care bills
  • Pays 19% of nursing home care
  • Pays for 21% of prescriptions
  • As likely as privately insured to find a primary care

physician or specialist

  • 91% of physicians (US and CT) accept new Medicare

patients

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Access to care

  • 40%
  • 30%
  • 20%
  • 10%

0% 10% 20% 30% 40% hospitalization

  • utpatient

SNF hospice home health doc, suppliers

Medicare utilization

% difference, per person, CT vs. US, 2012

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Financing

  • Part A funded by 2.9% payroll tax, split equally between

workers and employers

  • Parts B and D funded by premiums, regular taxes
  • Concerns about long term viability
  • ACA, slow growth in spending help – now has until 2030
  • Out from 2017 before national reform
  • Concern about ratio of workers to beneficiaries as baby

boomers age

  • Spending per person is not even
  • But rates of increase similar to private insurance
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Financing

  • In 2016 Medicare spent $7.4 billion on Medicare for CT

residents

  • All federal funding
  • CT residents cost $11,964/person
  • 6th highest among states
  • Our higher utilization rates
  • US average $10,986
  • CT per person spending rising 5.4%/year on average

(1991-2016)

  • US rising 5.2%
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90% 43% 10% 57%

NOTES: Excludes Medicare Advantage enrollees. Includes noninstitutionalized and institutionalized beneficiaries. SOURCE: Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Cost and Use File, 2009.

Distribution of Traditional Medicare Beneficiaries and Medicare Spending, 2009

Total Number of Traditional Medicare Beneficiaries:

35.4 million

Total Traditional Medicare Spending:

$343 billion

Average per capita Traditional Medicare spending: $9,702 Average per capita Traditional Medicare spending among top 10%: $55,763 Average per capita Traditional Medicare spending among bottom 90%: $4,584

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0% 5% 10% 15% 20% 25%

1970 1975 1980 1985 1990 1995 2000 2005 2010

Medicare (Average Annual Growth, 1970-2011 = 7.9%) Private Health Insurance (Average Annual Growth, 1970-2011 = 9.1%)

NOTE: Comparison includes benefits commonly covered by Medicare and Private Health Insurance. These benefits are hospital services, physician and clinical services, other professional services and durable medical products. SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group: National Health Expenditure Historical Data, 2013.

Annual Change in Per Enrollee Medicare and Private Health Insurance Spending, 1970-2011

A n n u a l P e r c e n t C h a n g e

Medicare Private Health Insurance

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Trends

  • Medicare enrollment growing – aging and disabled up
  • Medicare finances – concerns but slower growth in costs

continue, date the Medicare Trust Fund will run out of money is now 2030

  • Not “bankruptcy”
  • Medicare will still pay 80 to 86% of benefits past 2030 with

incoming payroll taxes, will be a revenue shortfall

  • Only applies to Part A – physician and drug coverage are

not affected

  • Later than in 2010 when ACA passed
  • Due to slower growth, stop overpaying managed care

plans, reforms

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New proposals

  • ACA repeal would mean donut hole in drug coverage opens

again

  • Lose free preventive care – check ups, mammograms
  • Would increase Medicare spending by $802 billion by

eliminating cost reductions, reforms

  • That would increase premiums and cost sharing for

beneficiaries

  • Proposals to shift to a voucher system
  • Purpose is to save money for the federal government, so

vouchers wouldn’t be generous

  • Beneficiaries would have to buy coverage in the private

market

  • Unlikely vouchers would equal cost for private insurance

as current Medicare costs are a bargain