Wrapping Around Medicare

Wrapping Around Medicare

The Role of Medicaid

Prepared by

James M. Verdier Mathematica Policy Research, Inc.

for the

National Health Policy Forum

Washington, DC February 6, 2009

Introduction and Overview

Coverage gaps in Medicare ? Long-term care ? Vision, dental, hearing, transportation services

Significant beneficiary cost sharing for most Medicare benefits ? Hospital, physician, nursing facility services, Rx drugs, outpatient mental health services

Medicaid fills many of these coverage gaps and covers most premiums and cost sharing for those with low incomes and disabilities ("dual eligibles")

Medigap plans and employer-sponsored insurance may fill coverage gaps and pay cost sharing for those with higher incomes ? Addressed in other presentations

1

Medicare Coverage Gaps

Medicare does not cover: ? Most long-term care (nursing facilities, home- and community-based services) ? Most vision, dental, and hearing services ? Routine physical exams ? Most non-emergency transportation ? For details and exceptions, see "Medicare & You, 2009," p. 38



Medicare Advantage (MA) managed care plans may cover some of these services ? MA Special Needs Plans (SNPs) that serve dual eligibles are especially likely to do so

2

Medicare Beneficiary Premiums and Cost

Sharing in 2009

Premiums ? Part A (hospitals) Up to $5,316 per year in some limited cases ? Part B (physicians and other) $1,157 to $3,700 a year, depending on income ? Part C (managed care) and Part D (Rx drugs) Varies by plan

Deductibles, coinsurance, and copayments ? Hospital stay $1,068 deductible ? Skilled nursing facility stay $0 for first 20 days, $133.50 per day for days 21-100 ? 20% coinsurance for most other services ? Parts C and D Varies by plan

For more details, see "Medicare & You," pp. 124-127

3

Medicaid Coverage for Dual Eligibles

State Medicaid programs cover many of the services Medicare does not, primarily long-term care ? Medicaid coverage of vision, dental, hearing, transportation and other services varies widely by state ? "Full" dual eligibles receive this coverage from Medicaid, but Medicare is first payer Where Medicare and Medicaid coverage overlaps (nursing facilities, home health), providers must bill Medicare first Full dual eligibles receive all Medicaid benefits "Partial" duals only have coverage of Medicare premiums and cost sharing

4

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download