PUBH 3135W Lecture Notes - Lecture 15: Medicare Advantage, Medigap, Managed Care
Document Summary
Over 65 years of age and qualify for social security benefits. Disability: qualify for ssdi and collected benefits for at least 24 months. Diagnosis of esrd or lou gehrig"s disease, receiving ssdi. Must be us citizens or permanent legal resident. Entitlement to part a, eligibility to enroll in parts b, c, d. Skilled nursing facility care after 20 days. Insurance coverage for out of pocket costs not covered by a and b. Cover both part a and part b deductible. Medicare beneficiaries with low income and modest assets. Medicaid pay for medicare premiums and cost sharing. Patient enroll in private managed care plan. Medicare pay insurance company a capitated rate for covering beneficiary. Created by medicare modernization act of 2003. Penalty if don"t enroll when eligible and go without equivalent coverage. Sliding scale small edition premium if high income. Changes in rx spending, hospital readmissions, home health. Distribution of traditional medicare beneficiaries and medicare spending.
