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Medicare and Medicaid

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Miranda Huffman

on 6 February 2018

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Transcript of Medicare and Medicaid

Public Insurance
Medicare and Medicaid
1. State based
2. Primarily for children
and pregnant women
3. Income-based

1. Federal Program
2. Primarily for individuals over age 65
3. Has multiple parts
1. Started in 1965
2. Signed by President L.B. Johnson
3. Part of the Social Security Act
1. Started in 1965
2. Signed by President L.B. Johnson
3. Part of the Social Security Act
Federally managed program by the Center for Medicare and Medicaid (CMMS)
Federal government sets minimum requirements and provides some money

States manage the program and provide the rest of the money
1. Anyone over age 65
2. Anyone who has qualified for disability for at least 24 months
3. Anyone with end-stage renal disease on dialysis
4. Anyone with amyotrophic lateral sclerosis
Who gets coverage?
Varies from state to state, but in general:
1. Children
2. Pregnant women
3. Elderly
4. Individuals with a chronic medical condition

Who are at or below the federal poverty limit
Who gets covered?
Varies from state to state

1. Prenatal care, delivery care, 6wk PP visit
2. Well child visits and immunizations
3. Office visits
4. Hospitalizations
5. Nursing home care
6. Home health aides
7. Medications
8. Dental visits
What does it cover?
What gets covered?
Automatically qualify for coverage at age 65
Covers care in the hospital or nursing home
Covers home health services and hospice
Part A
Have to apply for coverage
Covers visits to the doctor, labs, radiology studies
Covers durable medical equipment
Covers mental health services
Only covers 80% of most things
Part B
You have the choice to join a managed care program instead of accepting Part B and D
Part C
Medication coverage
Part D
Part of the Affordable Care Act makes it so Medicare Part B covers 100% of preventive services
You agree to follow a set of rules in exchange for other perks
For example, no copay on services if in-network
Dental services
Medication coverage
Why would you do that?
Old and disabled patients
Parts A,B,&D or C
State (plus federal)
Pregnant, children,
poor, disabled
By the completion of this session, you will be able to:
1. Explain the difference between Medicare and Medicaid
2. Educate your patients on insurance terminology
3. Analyze a formulary to determine the cheapest medications for a patient
Frank Harris
80YOM with history of type 2 diabetes, asthma, and previous heart attack. Presents after a recent heart attack. He reports he wasn't taking his medications because of cost.

Here's his medicine list:
Lipitor 20mg once daily
Proventil 2 puffs inhaled every 4 hours as needed
Atacand 16mg once daily
Hydrochlorothiazide 25mg once daily
Bydureon 2mg injected once weekly
Aspirin 81mg daily
Download Kahoot app
Go to www.kahoot.it
Miranda M. Huffman, MD, MEd
Full transcript