UHC : Medicare/Medicaid

Medicare - established based on the need of health insurance for the elderly; was added as an Amendment to the Social Security Act (Title XVIII) Medicare Eligibilities - Requires that individuals have worked at least 10 years in Medicare-covered employment or have paid taxes into the Medicare system, are US Citizens or permanent residents, and are at least 65 years old. People under 65 may qualify for Medicare if they have End-Stage Renal Disease and require dialysis or a kidney transplat or if they recieve Social Security disability benefits (and have been for at least 24 months) Medicare Enrollment and Spending - Enrollment: 57 Million Spending: $680 Billion Medicare: Part A - Hospital Insurance: Covers in-patient hospital care and other types of institutional care Medicare Part A Benefit Period - A deductible of $1316 is paid at the beginning of each period, which begins when a person enters the hospital and ends when a person has not been a patient in a hospital or skilled nursing facility for 60 consequtive days (90 day periods total) 60 day lifetime reserve days are available once the 90 days of the benefit period have been used 190 day lifetime supply of inpatient psychiatric care is separate from the benefit periods and reserve days Individual also receives 100 days per benefit period at a skilled nursing facility care for short-term skilled care (not custodial care - should be care only provided in nursing homes) that can only be used if preceded by a hospital stay of at least 3 daysHospice care (for patients with a life expectancy of less than 6 months that have waived the right to traditional treatment) is offered with very little patient cost-sharing (Pay 5% of Rx Drugs, repite care, grief counseling) Medicare is not applicable if traveling outside of the US Funding comes from payroll taxes from employees and employers Medicare Part B - Supplementary Medical Insurance (SMI) Includes physician services, a variety of outpatient services, home health care, drugs that are not selfadministered, and a variety of preventative services Everyone eligible/receiving Part A can choose to purchase Part B; a 10% penalty on the premium is applied every year Part B is not purchased by an eligible individual Everyone on Part B is charged a monthly premium that is automatically taken out of their social security check Part B Cost Sharing - Includes annual deductible of $183 plus 20% of approved charges (what Medicare is willing to pay)