1 Medicare & Medicaid (1/3) -- MO141 Patient Advocacy

1 Medicare & Medicaid “US Healthcare system Chapter 5” by Deanna L. Howe, Andrea L. Dozier, Sheree O. Dickenson, University of North Georgia Press is licensed under CC BY-SA 4.0 1.1 LEARNING OBJECTIVES By the end of this chapter, the student will be able to: - Compare Original Medicare and the different parts (Part A and Part B) and Medicare Part D with Medicare Advantage, also known as Part C - Describe the two trust funds that pay for or support Medicare - Discuss Medicaid and the Children’s Health Insurance Program (CHIP) - List two objectives of the Patient Protection and Affordable Care Act - Discuss four healthcare delivery reforms of the Affordable Care Act (ACA) - Describe the breakdown of costs for federally-funded healthcare services proposed for federal year (FY) 2020 1.2 KEY TERMS - Basic Health Program - Centers for Medicare and Medicaid Services - Children’s Health Insurance Program (CHIP) - Medicaid - Medicare - Medicare Part A - Medicare Part B - Medicare Advantage (Part C) - Medicare Part D - Medigap - Original Medicare - Patient Protection and Affordable Care Act (Affordable Care Act, ACA, Obamacare) 1.3 INTRODUCTION Healthcare is paid for by federal or state funds, private insurance, or private pay. Health insurance is important to assist with the costs of healthcare but, arguably, most important to provide individuals easier access to healthcare. Most persons aged 65 and older are covered by Medicare, having paid into the Social Security system during employment for at least ten years or forty quarters (U.S. Department of Health and Human Services [HHS], n.d.). For individuals under 65 years of age and noninstitutionalized, the Congressional Budget Office (CBO, 2018) projected that the majority of individuals (89%) would also have health insurance. Most health insurance for individuals under 65 years of age is from employment-based plans (two thirds). Government and state-subsidized Medicaid or Children’s Health Insurance Program (CHIP) accounts for about one fourth of those with insurance. Others are insured with Medicare, nongroup policies, or other forms (about 4%), leaving 29 million people (11%) uninsured (CBO, 2018). The total cost for government-subsidized healthcare insurance—Medicare, Medicaid, and CHIP—was $1.3 trillion in 2016, comprising 38% of all healthcare expenses (Klees et al., 2018). In this chapter, we will explore federal and state-funded health insurance in greater detail. We also look at the U.S. Department of Health and Human Services (HHS) and identify services provided by the federal government for the health of all citizens. 1.4 FEDERALLY-FUNDED HEALTHCARE The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. government’s Health and Human Services department (HHS). CMS administers and operates the Medicare program. Medicaid, although administered by individual states, also receives oversight by CMS (CMS, n.d.a). Medicare Medicare is subsidized health insurance for pers