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Health Care for Older Adults Pat Mezinskis April, 2008
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Health Insurance for Older Adults Older Americans Act of 1965: made funds available for the elderly Social Security Act of 1935: amended in 1965 to provide Medicare and Medicaid
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Medicare (Title XVIII) Federal health insurance program established for those over 65 Today it also includes some people with disabling diseases such as End Stage Renal Disease
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Medicare (Title XVIII) Payment is based on DRGs which is a prospective method of deciding costs rather than a retrospective method
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Medicare (traditional) Part A: funded through SS payroll taxes Covers: hospital services blood transfusions SNF (3 months or less) home health care hospice care inpatient psychiatric care
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Medicare (traditional) Part B: monthly premiums $93.50 for 2007 Covers: MD/nurse practitioner services outpatient services emergency services PT/OT/ST outpatient psychiatric services
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Medicare (traditional) Part B Covers: lab fees ambulance inpatient drugs
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Medicare (traditional) Part B Now covers some preventive services: mammography, prostate screening, glaucoma screening, bone density measurements, diabetes ed., colorectal cancer screening, pap smears, some vaccinations
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Medicare Home Care Benefit Provides acute or restorative skilled nursing care Intermittent or short-term basis For homebound patients under care of a physician
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Medicare Not covered: Long-term nursing home care Routine physicals Dental care Eye exams, glasses Hearing exams, hearing aids
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Managed Medicare Part C- “Medicare Advantage” Must provide all that Medicare does Provides preventive care
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Medicare Part D 2006-NEW Prescription Drug Benefit Optional
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Medicaid (Title XIX) Assistance for the poor, uninsured “Means” tested- must be indigent to qualify Assets and income must not exceed your state’s defined poverty level Look-back period currently 3 years
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Medicaid Covers: Inpatient and outpatient hospital care Lab and x-ray services Physician services Skilled nursing home care
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Other Programs Ohio Passport Elderly Services Program (ESP) Supplemental Medigap LTC insurance
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Cost of Health Care Home Care- $15-30/hour Home Nursing Care- $35-75/hour Adult Day Service-$40-100/day Assisted Living-$125-200/day Nursing Home Care-$150-250/day
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Health Care Levels Independent Living Assisted Living Skilled Nursing Care Traditional nursing home Eden Alternative Green Houses Dementia Care or Memory Unit
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Health Care Regulations Nursing homes-licensed Medicare/Medicaid facilities-licensed and certified Highly regulated industry Only so many beds available in state
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Housing Options Life Care or Continuing Care Retirement Communities (CCRC) Foster Care Homesharing Assisted Living Facility Co Housing
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Community Resources Senior Centers Adult Day Care Respite Care Hospice Meals-on-Wheels
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