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Social Security and Medicare & Medicaid
NURS 4100 Care of the Older Adult Spring 2014Joy A. Shepard, PhD(c), MSN, RN, CNE
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Objectives
Analyze the benefits of Social SecurityDiscuss the phenomenon of retirement
as it relates to an aging societyCompare and contrast the Medicare
and Medicaid programsList the benefits and barriers to long-
term care insurance
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Changing Demographics
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Changing Demographics
Year 2001
Year 2011
Year 2021
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Age & Sex Structure of the US Population: 2010, 2030, & 2050
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Shifting Composition of the Workforce
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Social Security
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Social Security
Social Security Act of 1935 Federal Federal public retirement pension systemFull retirement age steadily rising (since
1980s)Major source incomeHas decreased poverty ratesMajor recipients female elderly
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Social Security
QualificationsFinancially sustainable? No means testProcrastination – bad policyWhat suggestions do YOU have to
save Social Security?Text of the 1935 Social Security Act
Review Question
Which of the following factors would not threaten the solvency of Social Security?
A. Baby Boomers taking early retirement. B. Means testing being implemented for Social
Security. C. Another recession or depression. D. Aging of the population.
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Retirement in an Aging Society
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Retirement
Phenomenon of retirement – How will it be redefined by the Boomers?
Decades of retirement - feasible?Social Security sufficient?Are Boomers prepared?“Third Age” career strategies
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Income Older Adults in America
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Medicare & Medicaid
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Medicare
Title XVIII of the Social Security Act (1965) Covers elderly and some disabled
– Part A – Hospital insurance– Part B
Supplemental medical insurance (physician care)Preventive services
Limited means test Covers ~ 45% of elders’ medical care bills
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Medicare Preventive Services
Prevention is any activity that reduces the burden of mortality or morbidity from disease. Services performed in a clinical setting that are designed to prevent disease, injury, or disability, prolong life, and promote health are known as preventive health services.
Examples: Screening, testing, counseling, immunization, preventive medication, and preventive treatment.
Help people avoid disease or injury (primary), delay the onset of disease (primary), detect disease in its earliest and most treatable state (secondary), or alter and change the course of chronic conditions by restoring function and reducing complications (tertiary).
Result: Longer, healthier, and more productive lives.
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Medicare Preventive Services (Part B):
One-time “Welcome to Medicare” preventive visit
Abdominal aortic aneurysm screening Alcohol misuse screenings and counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Colorectal cancer screenings Depression screenings Diabetes screenings
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Medicare Preventive Services Cont’d…
Diabetes self-management training Glaucoma tests HIV screenings Mammograms (screening) Nutrition therapy services Obesity screenings and counseling Pap tests and pelvic exams (screening) Prostate cancer screenings Sexually transmitted infections screening and cou
nseling
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Medicare Preventive Services Cont’d…
Shots: – Flu shots – Hepatitis B shots – Pneumococcal shots
Tobacco use cessation counseling Yearly "Wellness" visit http://www.medicare.gov/coverage/preventive-and-screening-ser
vices.html
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Medicare Related Resources
Medicare & You: Stay Healthy with Medicare’s Preventive Benefits (video)
Medicare & You: Women's Preventive Health (video)
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Medicare
Medicare Advantage – Part C
Voluntary Prescription Drug Benefit – Part D
24 http://downloads.cms.gov/files/TR2013.pdf
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Question
Hospital insurance for Medicare recipients is funded under:– A. Medicare Part A– B. Medicare Part B– C. Medicare Part C– D. Medicare Part D
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Medigap – Medicare Supplemental Insurance Policies
Medicare Supplemental Insurance
Private insurance – helps seniors pay for costs not covered by Medicare
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Medicare
Covers (with some limitations):– Skilled nursing in nursing facilities and subacute care
– Home health care– Hospice
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Medicare no longer covers the cost of 10 hospital-acquired conditions
Foreign object retained after surgery
Air embolism Blood incompatibility Stage III & IV pressure
ulcers Falls & trauma
Poor glycemic control Catheter-assoc UTI Vascular catheter-
associated infection Certain surgical site
infections (CABG, bariatric, orthopedic)
DVT or PE following TKR, hip replacement
For more information, please see http://www.cms.hhs.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp#TopOfPagehttp://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3227&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
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Review Question
Medicare recently issued a new ruling. It will cease paying for 10 preventable hospital-acquired conditions. Which of the following conditions are included in the new ruling?– A. Hematoma after venipuncture– B. Skin tear after being turned and
repositioned– C. Cellulitis after IV infusion– D. Pneumonia after aspirating on meal tray
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Medicaid
Title XIX Social Security Act (1965)Covers “medically indigent”Funded partly by federal and partly by Funded partly by federal and partly by
state governmentsstate governmentsRun by states under federal guidelinesRun by states under federal guidelinesNorth Carolina statistics
North Carolina Medicaid State PlanNorth Carolina Division of Medical Assistance
Latest Data: NC Medicaid Enrollments & PaymentsFMAP: Federal Share of Medicaid Costs
Rising Enrollments Federal Share/ State Share: 65.5%/ 34.5%
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Medicaid
Covers (depending on state’s program):– Nursing care
facilities– Assisted living– Home health
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Affordable Care Act of 2010 Expands Medicaid Eligibility in 2014
The Affordable Care Act of 2010, signed by President Obama on March 23, 2010, creates a national Medicaid minimum eligibility level of 133% of the federal poverty level ($29,700 for a family of four in 2011) for nearly all Americans under age 65.
This Medicaid eligibility expansion goes into effect on January 1, 2014 but states can choose to expand coverage with Federal support anytime before this date-see related Federal Policy Guidance and states that have expanded Medicaid prior to 2014.
States can also choose to opt out of the expansion. See eligibility provisions in the Affordable Care Act.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html
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Review Question
What is federally mandated and state administered?
A. MedicaidB. Medicare
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Review Question
_________ is a $498 billion public health insurance program for low-income individuals and the largest long-term care program for the disabled and elderly.
A. MedicaidB. Medicare
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Review Question
Which of the following applies to Medicare and which applies to Medicaid? A. Federally administered, nationwide healthcare coverage program for elderly/ disabled B. Entitlement program—all individuals have a legal right to apply for the program; if they
meet the eligibility criteria, they are entitled to receive coverage C. Uniform: one set of requirements applies to all participating providers/ beneficiaries D. Joint federal/ state partnership: healthcare coverage for low-income individuals E. Differences among state programs: covered populations, benefits, cost sharing,
delivery systems and reimbursement to providers F. Means-tested program that provides benefits to certain categories of people who meet
rigorous income and asset rules G. States may cover other individuals under “waiver” programs H. Every state has a limit on what things (“assets”) a recipient may own and keep
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Ethical Issue: Transfer of Assets & “Spend Down”
Is transferring assets to qualify for Medicaid ethical?
Right to leave assets to children?
Should wealthy be subsidized?
Punished for being frugal?
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Long-Term Care Insurance
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Long-Term Care Insurance
Plan ahead for LTC costsMainly people over age 554-10% older population
coveredProvides 7% of total funding
for LTC