Medicare Part A Payment Plan Beneficiary Pays (2004) Hospital Stays 1-60 days$ days$210/day days$420/day 151+ daysall costs SNF 1-20 daysnothing days$105 per day max 101+ daysall costs

Medicare Part A Payment Plan Beneficiary Pays Home Health Care Nothing for approved home health care services 20% of approved durable medical equipment Hospice Co-payment of $5 for prescription drugs 5% of Medicare-approved amount for respite care

Medicare Part B Beneficiary Pays Medical & Other $100 deductible $58.70 per mo. premium 20% of Medicare approved physician cost 20% outpatient physical, occupational, & speech- language therapy 50% outpatient mental health care Full prescription med costs Home Health Care Nothing for Medicare- approved services 20% of Medicare- approved durable medical equipment

Medicare Part B Beneficiary Pays Clinical Lab Services Nothing for Medicare- approved services Outpatient Hospital Services 20% of billed amount after deductible

“Accepting Assignment” Payment to Physician Medicare PaysBeneficiary Pays Physicians accepting assignment 80% of approved charge 20% of co- payment Physicians not accepting assignment 80% of approved charge 20% co-payment + 15% of additional cost

Example of Accepting Assignment Medicare PaysBeneficiary Pays Physician accepting $100 per visit $80$20 Physician not accepting $120 per visit $80$20 + $3 (15% of $20)

Prescription Drug Benefit (2006) Premium - $35/mo; $420/yr Deductible - $250 Coverage – 75% of drug costs up to $2,250 Gap – no coverage between $2,500-$3,600 Catastrophic coverage – 95% of costs above $3,600 Low-income subsidies – premium, deductible, & coverage gap waived for those earning less than $12,123/yr & have less than $6,000 liquid assets Company incentive – tax-free subsidies to employers who maintain to insurance companies

Doctor & other Part B Coverage Changes Premium – increased on a sliding scale for those with incomes above $80,000 Deductible – raised in 2005 to $110 Company incentive - $12 billion in subsidies to private insurers that offer health plans; beginning 2010, Medicare would face competition from private plans Medicare savings accounts – tax shelters for individuals with deductibles above $1,000 for singles & $2,000 for couples

Medicare + Choice Plans Beneficiary Pays Part ASame payments Part B$58.70/mo. premium + additional Choice Plan’s premium (?) Choice Plan’s co-payments for services

Medicaid ·Monthly income of $242 for single & $317 for couple Spend down to $2,000 liquid assets for institutionalized spouse - Entire SSI goes to pay for institutionalization Community spouse can have between $17,856 - $89,280 in assets – Maximum monthly income $1,452 – Window – 3 yrs from date of institutionalization or 5 yrs for transfers to trust

Main Problems in Providing Care for Elderly Limited coverage under Medicare - homebound status - skilled nursing 1.4% or $13/mo increase in SSI – 1/3 rd of this will go for increase in Medicare premiums  Private insurance option at cost to elderly  Cost of home health care services expensive  Cost of long-term care expensive  Problems with Managed Care Plans