100% Guaranteed Pass
Health Law Creation - ✔✔Federal Statutes dominate
Arises from authority to "tax and spend" and "regulate interstate commerce"
(Article 1 of the US Constitution)
Entitlement - ✔✔a type of financial help provided by the government for
members of a particular group
Medicare and Medicaid - ✔✔Two very large entitlement programs that provide
health care and services.
Combined they serve more than one third of the US population.
Medicare - 60 million beneficiaries
Medicaid - 70 million beneficiaries.
Medicare - ✔✔Federal social insurance program.
Managed by Centers for Medicare and Medicaid Services (CMS).
Anyone 65 years or older is eligible.
On SSDI > 24 months.
ESRD patients who have been on dialysis for three months. (added by Nixon)
Those with ALS
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,Paying for Medicare - ✔✔40 %from general fund.
Rest from Medicare taxes, premiums, deductibles, SS taxes, etc...
Medicare Part A - ✔✔No premium for most.
Covers hospital stays and short term rehab (after $1300 deductible).
Covers some home health.
Covers 100% of hospice care including meds, staff, equipment in hospice
Will pay first 90 days of a hospital stay. Co-pay of about $300/day after day 60.
Also offers 60 "lifetime reserve" days beyond the 90. Co-pay of about $600/day
for these.
Medicare Part B - ✔✔Premium-based (most pay about $100/month).
Covers MD visits.
Preventive care.
Durable medical equipment (walker, shower chair, ect.)
Ambulance service.
$183 annual deductible then Medicare pays 80%, patient pays 20%
Medicare Part C - ✔✔AKA Medicare Advantage
Basically, a highly regulated but private replacement for Parts A and B.
Coverage and premiums vary.
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©KERRYMARTIN 2025/2026. YEAR PUBLISHED 2025.
,Not generally something lower income patients enroll in due to costs
Medicare Part D - ✔✔Large expansion of Medicare passed in 2003 under
President Bush.
Prescription drug plan. Cost estimate $92 billion in 2018
$400 annual deductible.
Avg $
̴ 40/mo premium. Varies with plan, income.
Pays 75% of drug costs, up to $2970 per year (now $3700 per year).
Then nothing until costs reaches $4750 at which point Medicare pays 95%.
Donut Hole (the hole between what Medicare D will pay for and what the pt has
to pay for)
ACA trying to close that hole by raising the amount Medicare D will pay
Medicaid - ✔✔Federal health insurance program for certain low-income and
disabled individuals.
Funded jointly by federal and state governments (50-80% federal).
Managed by states.
Eligibility largely determined at state level.
25% of all children covered by Medicaid.
50% of all Medicaid recipients are children.
Account for only 20% of cost.
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, Medicaid Eligibility - ✔✔Highly Variable
For adults, usually based on % of FPL (federal poverty level)
FPL is $12K for one adult. $20K for family of 3.
Examples:
AL - Parents - 18%; Childless adults - 0%.
32 states expanded Medicaid thru ACA, 138% for parents and childless adults.
NC - Parents - 44%; Childless adults - 0%.
Who is eligible? - ✔✔Those with low a income and are:
Children
Pregnant
Adult with dependent children
Disabled
Blind
States may apply to CMS to expand coverage to other groups. Some do, some
don't.
What does Medicaid cover? - ✔✔Hospital
MD visits
Rx
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©KERRYMARTIN 2025/2026. YEAR PUBLISHED 2025.