Kaiser Family Foundation. (2011). Restructuring Medicare\'s beneficiary design:
ID: 435012 • Letter: K
Question
Kaiser Family Foundation. (2011). Restructuring Medicare's beneficiary design: Implications for beneficiaries and spending. Retrieved from Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending.
Kaiser Family Foundation. (2012). Medicare's role for dual-eligible beneficiaries. Retrieved from Medicare’s Role for Dual Eligible Beneficiaries.
Address the following questions:
Identify one or two main points from each selected article.
Explain in detail the issues presented in the articles and their impact on the recipients of Medicare.
Explain in detail the issues presented in the articles and their impact on the providers to Medicare recipients.
Explanation / Answer
In the first article in 2011, the issues which impacted recipients and providers of Medicare patients are explained below:
According to Cubanski et al, 2011, the restructuring Medicare’s fee-for-service(FFS) benefit design, which was implemented in 2013 with a single deductible of $550 for Parts A and B, 20% coinsurance on almost Medicare-covered services, and a $5,500 annual limit on cost sharing in 2013 has only 5% saving for lower out-of-pocket spending, 41 million beneficiaries who have higher out-of-pocket spending. and around 24% people would have no changes. It is also found that the supplemental coverage plans are going to be expensive as there would be higher premiums. It would be a higher expense for those people who have lower utilization of medical benefits or no inpatient care. Only those people who have out-patients, inpatients, or any post-acute care services can maximum utilize the expenditures on medical benefits. With this Alternate Medicare benefit design, Medicare spending would reduce by $4.2 billion and Medicaid spending would decrease by $0.1 billion.
According to Jacobson et al, 2012, the impact on the low-income elderly and disabled people who are 20% of the population in which 31% is for Medicare spending and 39% for Medicaid spending. A combination of both the programs has helped the lower-income group whose income is below $2500. The services which are not covered under Medicare are covered by Medicaid. Up to 77% dual eligibles receive Medicaid benefits which help these low-income people. The dual eligibles have more inpatient stay, hospitalization, emergency room visits, post-acute care, need skilled nursing facility which is a huge expense on federal and state government. It is around $14,169 per person which is 1.8 times than the average people. These dual eligibles can either avail Medicare advantage plan or FFS plan. The initiatives were taken by The Centers for Medicare and Medicaid Services by implementing a capitated model and a managed fee-for-service model for financing these dual eligibles which will help in fiscal sustainability.
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