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RWJF National Program Project Report: Evaluation of the Medicare Supplementary Insurance Reform Legislation
National Program Project Report
(last updated January 2001)
Evaluation of the Medicare Supplementary Insurance Reform Legislation
NATIONAL PROGRAM
Changes in Health Care Financing and Organization
Summary
This four-year evaluation project examined the market for Medicare supplemental insurance (Medigap) before and after OBRA-90, which simplified comparison shopping for Medigap, to determine whether changes introduced in Medigap insurance policies decreased marketing abuses as well as confusion among elderly Americans. It found that consumers reported better understanding of which Medigap policies offer the most value for their money and appear to be spending more on Medigap policies after standardization because they are purchasing coverage with more benefits. Even so, they are less likely to purchase coverage for preventive care, at-home recovery, or prescription drugs.
TABLE OF CONTENTS
GRANT INFORMATION
BACKGROUND
THE PROJECT
FINDINGS
COMMUNICATIONS
BIBLIOGRAPHY
GRANT INFORMATION
PROJECT Evaluation of the Medicare Supplementary Insurance Reform Legislation
GRANTEE
PDF Incorporated
(Washington, DC)
$352,149
(September 1991 to July 1996)
ID# PC258
Contact
Project Director: Peter D. Fox, PhD
(301) 718-1015
75102.70@compuserve.com
RWJF GOAL AREAS
Access
— To assure that all Americans have access to basic health care at reasonable cost.
Chronic Care
— To improve care and support for people with chronic health conditions.
BACKGROUND
The Omnibus Budget Reconciliation Act of 1990 (OBRA-90) simplified comparison shopping for Medicare supplemental insurance, commonly known as Medigap.
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National Program Report
THE PROJECT
This four-year evaluation project examined the Medigap market before and after OBRA-90, to determine whether changes introduced in Medigap insurance policies decreased marketing abuses as well as the confusion elderly Americans often face when purchasing coverage. In California, Florida, Minnesota, Missouri, New York, South Carolina, Texas, Washington, and Wisconsin, the evaluation assessed how changes in Medigap insurance affected:
Medigap insurance products.
Access to and affordability of Medigap policies for beneficiaries.
The structure and operations of the insurance carriers that sell Medigap coverage.
Assessment tracked and compared implementation under different regulatory structures; interviewed consumers before and after the implementation of OBRA-90 to assess their awareness of and reaction to changes in Medigap insurance; and analyzed the impact of legislative changes on several existing Medigap policies.
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National Program Report
FINDINGS
Consumers report having an easier time understanding which Medigap policies offer the most value for their money.
Nearly three-fourths of Medigap consumers purchase plans that provide coverage for hospital care, skilled nursing home care, and physician services, and are less likely to purchase coverage for preventive care, at-home recovery, or prescription drugs.
Consumers appear to be spending more on Medigap policies after standardization, partly because they are seeking out and purchasing coverage with more benefits (e.g., coverage of non-assigned physician charges).
Insurers are dissatisfied that some types of coverage options disappeared under OBRA-90. Policies that reimburse only those expenses above a very large deductible are no longer available.
The researchers recommend that future policymaking efforts address:
Standardization of catastrophic coverage.
Differences in the regulation of managed care organizations and indemnity carriers that operate in the Medigap market.
Waivers allowing enrollees who purchase coverage with fewer benefits to bypass existing requirements for medical screening.
Methods for reducing the administrative burden on carriers, such as standardizing the actual wording of insurance policies and thereby precluding state variations.
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National Program Report
COMMUNICATIONS
The study team produced two articles, published in the Journal of Health Policy, Politics, and Law and the Journal of Aging and Social Policy (see the Bibliography).
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National Program Report
BIBLIOGRAPHY
(As provided by the grantee organization; not verified by RWJF; items not available from RWJF.)
Publications
Meyer JA, Silow-Carroll S, Tillmann IA and Rybowski LS. Employer Coalition Initiatives in Health Care Purchasing-Vol. 1 . Washington, DC: Economic and Social Research Institute, February 1996.
Meyer JA, Silow-Carroll S, Tillmann IA, and Rybowski LS. Employer Coalition Initiatives in Health Care Purchasing-Vol. 2 . Washington, DC: Economic and Social Research Institute, September 1996.
Print Coverage
Health Care Financing and Organization Findings Brief. "ESRI Study Explores Potential of Value-Based Purchasing in Employer-Based Coalitions." Volume 1, Issue 1. December 1996.
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National Program Report
Report Prepared by: Karin Gillespie
Reviewed by: Marian Bass, Molly McKaughan
Program Officer: Nancy L. Barrand
The Robert Wood Johnson Foundation PO Box 2316 · Princeton, NJ 08543 · (609) 452-8701
Results from search: http://aspe.hhs.gov/cfda/P93774.htm
CFDA: 93.774: Medicare: Supplementary Medical Insurance
CATALOG OF FEDERAL DOMESTIC ASSISTANCE
93.774: Medicare: Supplementary Medical Insurance
Popular Name:
Medicare
Objectives:
To provide medical insurance protection for covered
services to persons age 65 or over, to certain disabled persons and to
individuals with chronic renal disease who elect this coverage.
MAIN TOPICS:
ELIGIBILITY REQUIREMENTS
[ Applicant Eligibility |
Beneficiary Eligibility |
Credentials and Documentation ]
APPLICATION AND AWARD PROCESS
[ Preapplication Coordination |
Application Procedure |
Award Procedure |
Deadlines |
Range of Approval/Disapproval Time |
Appeals |
Renewals |
Criteria for Selecting Proposals |
Examples of Funded Projects |
Range of Assistance Given ]
RELATED PROGRAMS
PROGRAM ACCOMPLISHMENTS
FINANCIAL AND ADMINISTRATIVE INFO.
[ Federal Agency |
Type of Assistance |
Obligations |
Budget Account Number |
Authorization |
Regulations, Guidelines, and Literature ]
INFORMATION CONTACTS
[ Regional or Local Office |
Headquarters Office |
Web Site Address ]
ASSISTANCE CONSIDERATIONS
[ Formula and Matching Requirements |
Length and Time Phasing of Assistance |
Uses and Use Restrictions ]
POST ASSISTANCE REQUIREMENTS
[ Reports |
Audits |
Records ]
93.774 ELIGIBILITY REQUIREMENTS:
Applicant Eligibility:
All persons who are eligible for hospital
insurance benefits (see 93.773 ) and persons age 65 and older who reside
in the United States and are either citizens or aliens lawfully admitted
for permanent residence who have resided in the United States
continuously during the five years immediately preceding the month in
the application for enrollment is filed, may voluntarily enroll for
supplementary medical insurance (SMI). The beneficiary pays a monthly
premium. In calendar year 2001, the base premium is $50.00. Some States
and other third-party buy-ins pay the premium on behalf of qualifying
individuals.
Beneficiary Eligibility:
Persons age 65 and over, and persons
under age 65 who qualify for hospital insurance benefits.
Credentials/Documentation:
Proof of age, disability or lawful
admission status. This program is excluded from coverage under OMB
Circular No. A-87 .
93.774 APPLICATION AND AWARD PROCESS:
Preapplication Coordination:
None. This program is excluded from
coverage under E.O. 12372 .
Application Procedure:
Phone or visit the local Social
Security Office. Most persons entitled to hospital insurance are
enrolled automatically for supplementary medical insurance. Since the
program is voluntary, you may decline coverage. Persons not entitled to
hospital insurance must file an application. This program is excluded
from coverage under OMB Circular Nos. A-102 and A-110 .
Award Procedure:
After review of the application is completed,
the applicant will be notified by mail.
Deadlines:
Certain individuals may enroll during a special
enrollment period (SEP) if they are covered under a group health plan
(GHP) when first eligible to get Medicare: (1) individuals age 65 or
older who are covered under a GHP based on their own or a spouse's
current employment; and (2) disabled individuals under age 65 who are
covered under a GHP based on their own or any family member's current
employment. If the coverage of disabled individuals under age 65 was not
through a large group health plan (LGHP), that is, a plan that covers
employees of a least one employer that normally employs at least 100
employees, no family member other than a spouse qualifies for a special
enrollment period. An SEP enrollment may occur during any month the
individual is covered under the GHP based on current employment or,
during the eight month period that begins the first month after
employment or GHP coverage ends, whichever occurs first. Months of
coverage under the GHP based on current employment are excluded from the
calculation of the premium surcharge.
Range of Approval/Disapproval Time:
Not applicable.
Appeals:
Phone or visit the local Social Security Office or
the Medicare payment organization responsible for the initial
determination. The appeal process ranges from reviews, of the initial
determinations to formal hearings and, in cases meeting certain
criteria, reviews by Federal Courts.
Renewals:
Not applicable.
Criteria for Selecting Proposals:
Not applicable.
Examples of Funded Projects:
Not applicable.
Range and Average of Financial Assistance:
Generally, with
exceptions for certain services, the beneficiary is responsible for
meeting the an annual $100 deductible before benefits may begin.
Thereafter, Medicare pays a percent of the approved amount for the
covered service. For many services, this percentage is 80 percent. For
other services, the percentage that Medicare pays will vary from 100
percent to 50 percent depending upon the category of service.
93.774 RELATED PROGRAMS:
57.001 Social Insurance for Railroad Workers;
64.012 Veterans Prescription Service;
64.013 Veterans Prosthetic
Appliances;
93.246 Health Centers Grants for Migrant and Seasonal
Farmworkers;
93.773 Medicare: Hospital Insurance;
93.778 Medical Assistance Program (Medicaid);
96.001 Social Security: Disability Insurance.
93.774 PROGRAM ACCOMPLISHMENTS:
In fiscal year 2000, 37,226,000 persons
were enrolled for supplementary medical insurance. In fiscal year 2001,
the number of enrollees is estimated to be 37,570,000. In fiscal year
2002, the number of enrollees is estimated to be 37,905,000.
93.774 FINANCIAL AND ADMINISTRATIVE INFO:
Federal Agency:
HEALTH CARE FINANCING ADMINISTRATION, DEPARTMENT
OF HEALTH AND HUMAN SERVICES
( Home Page )
Type of Assistance:
Direct Payments for Specified Use.
Obligations:
(Benefit Outlays) FY 00 $88,874,742,000; FY 01 est
$102,698,000,000; and FY 02 est $110,124,000,000.
Budget Account Number:
20-8004-0-7-571.
Authorization:
Social Security Act Amendments of 1965, Title
XVIII, Part B, Public Law 89-97, as amended; Public Laws 90-248, 92-603,
93-233, 94-182, 95-210 and 95-292, 42 U.S.C. 1395 et seq.; Social
Security Disability Amendments of 1980, Public Laws 96-265 and 97-248;
Section 1, Public Law 98-21; Subtitle A, Public Law 98-369, as amended;
Public Laws 98-460, 99-272, 99-509, and 100-203, 42 U.S.C. 1305 Note;
Medicare Catastrophic Coverage Repeal Act of 1988, Title I, Subtitle B,
Title II, Subtitles A and B, Title IV, Subtitle B and C, Public Law 100-360; Medicare Catastrophic Coverage Repeal Act of 1989, Title II,
Public
Law 101-234; Omnibus Budget Reconciliation Act of 1989, Public Law 101-239; Omnibus Budget Reconciliation Act of 1990, Public Law
101-508;
Omnibus Budget Reconciliation Act of 1993, Public Law 103-66; Social
Security Act Amendments of 1994, Public Law 103-432; Health Insurance
Portability and Accountability Act of 1996, Public Law 104-191; Contract
with America Advancement Act of 1996, Public Law 104-121; Balanced
Budget Act of 1997, Public Law 105-33; Balanced Budget Refinement Act of
1999, Public Law 106-113; Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000, Public Law 106-554.
Regulations, Guidelines, and Literature:
Code of Federal
Regulations, Title 20, Parts 401, 405, and 422; Title 42, Parts 401,
405, 407, 408, 410, 413, 416, and 417. "Your Medicare Handbook," and
other publications are available from any Social Security Office without
charge.
93.774 INFO CONTACTS:
Regional or Local Office:
Consult Appendix IV of the Catalog for
listing of Regional Offices.
Headquarters Office:
Center for Beneficiary Services, Health Care
Financing Administration, Room C5-19- 07, 7500 Security Blvd.,
Baltimore, MD 21244. Phone: (410) 786-3870.
Web Site Address:
http://www.hcfa.gov
(See Appendix IV for more contact info.)
93.774 ASSISTANCE CONSIDERATIONS:
Formula and Matching Requirements:
This program has no statutory
formula or matching requirements.
Length and Time Phasing of Assistance:
Not applicable.
Uses and Use Restrictions:
Managed care benefits are paid on the
basis on Medicare capitation rates. Fee-for-service benefits are paid on
the basis of fee schedules or other approved amounts of services
furnished by physicians and other suppliers of medical services to aged
or disabled enrollees. Benefits are paid on the basis of prospective
payment system for covered services furnished by participating providers
such as hospitals and home health agencies.
93.774 POST ASSISTANCE REQUIREMENTS:
Reports:
None.
Audits:
None.
Records:
None.
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Text updated: December 2001
Results from search: http://www.esa.int:8080/handy/om/distr/doc/cfda/p93774.htm
CFDA: 93.774: Medicare: Supplementary Medical Insurance
93.774: Medicare: Supplementary Medical Insurance
Popular Name:
Medicare
Objectives:
To provide medical insurance protection for covered
services to persons age 65 or over, to certain disabled persons and to
individuals with chronic renal disease who elect this coverage.
MAIN TOPICS:
ELIGIBILITY REQUIREMENTS
[ Applicant Eligibility |
Beneficiary Eligibility |
Credentials & Documentation ]
APPLICATION & AWARD PROCESS
[ Preapplication Coordination |
Application Procedure |
Award Procedure |
Deadlines |
Range of Approval/Disapproval Time |
Appeals |
Renewals |
Criteria for Selecting Proposals |
Examples of Funded Projects |
Range of Assistance Given ]
RELATED PROGRAMS
PROGRAM ACCOMPLISHMENTS
FINANCIAL & ADMINISTRATIVE INFO.
[ Federal Agency |
Type of Assistance |
Obligations |
Budget Account Number |
Authorization |
Regulations, Guidelines, & Literature ]
INFORMATION CONTACTS
[ Regional or Local Office |
Headquarters Office ]
ASSISTANCE CONSIDERATIONS
[ Formula & Matching Requirements |
Length & Time Phasing of Assistance |
Uses & Use Restrictions ]
POST ASSISTANCE REQUIREMENTS
[ Reports |
Audits |
Records ]
93.774 ELIGIBILITY REQUIREMENTS:
Applicant Eligibility:
All persons age 65 and over, and those
under age 65 who are eligible for hospital insurance benefits (see
93.773), may voluntarily enroll for supplementary medical insurance
(SMI). The beneficiary pays a monthly premium. In calendar year 1996,
the base premium is $42.50. Some States and other third-party buy-ins
pay the premium on behalf of qualifying individuals.
Beneficiary Eligibility:
Persons age 65 and over, and persons
under age 65 who qualify for hospital insurance benefits.
Credentials/Documentation:
Proof of age or disability. This
program is excluded from coverage under OMB Circular No. A-87.
93.774 APPLICATION & AWARD PROCESS:
Preapplication Coordination:
None. This program is excluded from
coverage under E.O. 12372.
Application Procedure:
Phone or visit the local Social
Security Office. Most persons entitled to hospital insurance are
enrolled automatically for supplementary medical insurance. Since the
program is voluntary, coverage may be declined. This program is
excluded from coverage under OMB Circular Nos. A-102 and A-110.
Award Procedure:
After review of the application is completed, the
applicant will be notified by mail.
Deadlines:
An eligible individual who declines enrollment at first
eligibility may enroll during any general enrollment period (the first 3
months of each year). The monthly premium amount is increased by 10
percent for each 12 months in which a person could have been, but was
not enrolled. Certain individuals may also enroll during special
enrollment periods based on coverage by an employer group health plan
(EGHP): (1) individuals age 65 or older and employed, or the spouse of
an employed person; or (2) individuals under age 65 and employed, or the
family member of an employed person. If the coverage of individuals
under age 65 and employed was not through a large group health plan
(LGHP), that is, a plan of an employer of 100 or more employees or of a
group of employers at least one of which had 100 or more employees, no
family member other than the spouse qualifies for the special enrollment
period. (The special enrollment period is the first 7 months after
employment ends for the aged individuals, and the first 7 months after
the EGHP stops being the primary payer for health care services for the
disabled.) The premium surcharge may also be reduced for these
individuals.
Range of Approval/Disapproval Time:
Not applicable.
Appeals:
Phone or visit the local Social Security Office or
the Medicare payment organization responsible for the initial
determination. The appeal process ranges from a review to a formal
hearing. No judicial review is provided.
Renewals:
Not applicable.
Criteria for Selecting Proposals:
Not applicable.
Examples of Funded Projects:
Not applicable.
Range & Average of Financial Assistance:
The beneficiary is
responsible for meeting an annual $100 deductible before benefits may
begin. Thereafter, Medicare pays 80% of the fee schedule amount
or the reasonable costs for covered services.
93.774 RELATED PROGRAMS:
57.001 , Social Insurance for Railroad Workers;
64.012 , Veterans Prescription Service;
64.013 , Veterans Prosthetic
Appliances;
93.246 , Migrant Health Centers Grants;
93.773 ,
Medicare: Hospital Insurance;
93.778 , Medical Assistance Program;
96.001 ,
Social Security: Disability Insurance.
93.774 PROGRAM ACCOMPLISHMENTS:
In fiscal year 1995, 5,498,000 persons
were enrolled for supplementary medical insurance, and 2,778,000 had
payments made on their behalf for covered services. In fiscal year 1996,
the estimated number of enrollees increased to 36,006,000. In fiscal
year 1997, the estimated number of enrollees will be 36,490,000.
93.774 FINANCIAL & ADMINISTRATIVE INFO:
Federal Agency:
HEALTH CARE FINANCING ADMINISTRATION, DEPARTMENT
OF HEALTH AND HUMAN SERVICES
Type of Assistance:
Direct Payments for Specified Use.
Obligations:
(Benefit Outlays) FY 95 $63,481,712,000; FY 96 est
$69,055,000,000; and FY 97 est $76,287,000,000.
Budget Account Number:
20-8004-0-7-571.
Authorization:
Social Security Amendments of 1965, Title XVIII,
Part B, Public Law 89-97, as amended; Public Laws 90-248, 92-603,
93-233, 94-182, 95-210 and 95-292, 42 U.S.C. 1395 et seq.; Social
Security Disability Amendments of 1980, Public Laws 96-265 and 97-248;
Section 1, Public Law 98-21; Subtitle A, Public Law 98-369, as amended;
Public Laws 98-460, 99-272, 99-509, and 100-203, 42 U.S.C. 1305 Note;
Medicare Catastrophic Coverage Act of 1988, Title I, Subtitle B, Title
II, Subtitles A and B, Title IV, Subtitle B and C, Public Law 100-360;
Medicare Catastrophic Coverage Repeal Act of 1989, Title II, Public Law
101-234; Omnibus Budget Reconciliation Act of 1989, Public Law 101-239;
Omnibus Budget Reconciliation Act of 1990, Public Law 101-508; Omnibus
Budget Reconciliation Act of 1993, Public Law 103-66; Social Security
Act Amendments of 1994, Public Law 103-432.
Regulations, Guidelines, & Literature:
Code of Federal
Regulations, Title 20, Parts 401, 405, and 422; Title 42, Parts 401,
405, 407, 408, 410, 413, 416, and 417. "Your Medicare Handbook," (SSA)
79-10050, and other publications are available from any Social Security
Office without charge.
93.774 INFO CONTACTS:
Regional or Local Office:
Consult Appendix IV of the Catalog for
listing of Regional Offices.
Headquarters Office:
Carol Walton, Director, Bureau of Program
Operations, Health Care Financing Administration, Room 52-01-09, 7500
Security Blvd., Baltimore, MD 21244. Phone: (410) 786-8050.
Use the same number for FTS.
93.774 ASSISTANCE CONSIDERATIONS:
Formula & Matching Requirements:
This program has no statutory
formula or matching requirements.
Length & Time Phasing of Assistance:
Not applicable.
Uses & Use Restrictions:
Benefits are paid on the basis of fee
schedules or reasonable charges for covered services furnished by
physicians and other suppliers of medical services to aged or disabled
enrollees. Benefits are paid on the basis of reasonable costs for
covered services furnished by participating providers such as hospitals
and home health agencies.
93.774 POST ASSISTANCE REQUIREMENTS:
Reports:
None.
Audits:
None.
Records:
None.
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medicare, supplementary medical insurance - FCNL
Issues
We Work On — Health
Care
More
on Health Carex
Date
Last Reviewed: 4/23/02
How
Medicare Works
The current
Medicare program has two basic components: Part A and Part B.
Medicare Part A provides coverage of inpatient hospital services,
some skilled nursing, post-institutional home health services,
and hospice care. These benefits are provided to all Medicare-eligible
persons. Part A is financed by a payroll tax (employees contribute
1.45% of their earnings and employers provide a matching amount),
deductibles, and some copays. This money is held in the Hospital
Insurance Trust Fund to pay Part A benefits.
Medicare
Part B, Supplementary Medical Insurance, helps pay for the cost
of physician services, outpatient and lab services, psychiatric
care, physical and occupational therapy, medical equipment and
supplies, and some preventive services. Participation is voluntary,
though most who are eligible elect this option. Benefits are
financed through premiums, an annual deductible, copays, and
some taxpayer revenue. In order to keep down Medicare expenditures
and limit out-of-pocket costs charged to beneficiaries, the
government has capped the fees which Medicare-participating
providers can charge for Medicare-covered services.
The gaps
in benefits offered by Medicare Parts A and B can be filled
in several ways. For some retirees, employer-provided supplemental
insurance may provide benefits not offered through Medicare.
Alternatively, beneficiaries with financial means may purchase
private supplemental insurance policies, referred to as Medigap.
All Medigap policies must provide a minimum benefits package
(e.g. Part A and Part B coinsurance, hospital coverage beyond
Part A) and may offer optional benefits (e.g. a prescription
drug plan). Medicare beneficiaries who are very poor may qualify
for some Medicaid assistance. For more than 7 million seniors
and disabled persons (nearly 20% of the Medicare population),
Medicare is their only health insurance.
Congress,
in the 1997 Balanced Budget Act, created Medicare Part C (also
known as Medicare+Choice). This is not a third component of
Medicare but a mechanism intended to help reduce Medicare expenditures.
Part C is designed to encourage Medicare-eligible persons to
enroll in managed care organizations (viewed as less expensive)
instead of remaining in point-of-service plans.
This
article was originally published in the March 1999 FCNL Washington
Newsletter.
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The Medicare Watch website
The Century Foundation
and Medicare Reform Through
its publications, task forces, and online activities, The
Century Foundation strives to assess and encourage reforms that will improve Medicare
without undermining its character as a universal social insurance program.
In keeping with its concerns about social and economic inequalities among Americans, the
foundation is especially interested in promoting reforms that might reduce or
eliminate the disadvantages faced by vulnerable populations within Medicare.
Recent Reports and Findings
on Medicare
From prescription drug coverage to Medicare's
financing, this section steers you to timely and critical reports released by
the nation's premier health care foundations, think tanks, and consulting firms.
2002
Annual Report of the Board of Trustees of the Federal Hospital Insurance
and Federal Supplementary Medical Insurance Trust Funds
Release
of The Report of the Century Foundation Task Force on Medicare Reform
Century
Foundation Issue Brief Looks at Home and Community-Based Long-term Care Services
click
here for a complete list of
reports and findings on Medicare.
Medicare in the News
MEDICARE TRUSTEES REPORT GROWTH IN MEDICARE SPENDING, LONGER LIFE FOR
TRUSTFUND
Read the Report:
2002 Annual Report of the
Board of Trustees of the Federal Hospital Insurance and Federal
Supplementary Medical Insurance Trust Funds
Read the Story:
Medicare,
Social Security Programs Stable (Associated Press)
H.M.O.'s PLAN TO DROP MEDICARE, CALLING FEES TOO LOW
Read the
News Story
PUBLICATIONS OF INTEREST
Results from search: http://www.hcfa.gov/pubforms/tr/
2002 HI & SMI Trustees Report
Health Care Financing Administration
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2002 Annual Report of the Boards of Trustees of the Hospital Insurance and Supplementary Medical Insurance Trust Funds
The Medicare program is the second-largest social insurance program in the United States, with 40 million beneficiaries and total expenditures of $245 billion in 2001.
The Boards of Trustees for Medicare report annually to the Congress on the financial operations and actuarial status of the program.
Beginning in 2002, there is one combined report discussing both the Hospital Insurance program ("Part A" of Medicare) and the Supplementary Medical Insurance program ("Part B") .
The Office of the Actuary in CMS prepares the report under the direction of the Boards.
The Boards of Trustees issued their most recent report on March 26, 2002.
The Trustees Report is a detailed, lengthy document, containing a substantial amount of information on the past and estimated future financial operations of the Hospital Insurance and Supplementary Medical Insurance Trust Funds.
We recommend that readers begin with the "Overview" section of the report.
This section is fairly short, is written in "plain English," and summarizes all the key information concerning the expected financial outlook for Medicare.
Substantial additional material is available in the later sections for those wishing to delve more deeply into the actuarial projections.
2002 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust and Federal Supplementary Medical Insurance Trust Funds
Table of Contents, Tables & Figures
PDF format (967K Bytes)
2001 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund
Table of Contents, Tables & Figures
PDF format (567K Bytes)
2001 Annual Report of the Board of Trustees of the Federal Supplementary Medical Insurance Trust Fund
Table of Contents, Tables & Figures
PDF format (520K Bytes)
Other Reports
Technical Panel Review of Assumptions and Methods of the Medicare Trustees' Financial Projections (December 2000)
The Board of Trustees also issues a report on the financial status of the Old-Age and Survivors Insurance (OASI) and the Disability Insurance (DI) Trust Funds, as well as a summary of the Social Security and Medicare reports. These documents are available from the Social Security Administration.
OASDI Trustees Report
Status of the Social Security and Medicare Programs (Trustees' Summary)
Contact
All questions on the Medicare Trustees Report should be emailed to
DMMCE@cms.hhs.gov .
To expedite this process, please mention "Trustees Report" in your request.
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Medicare
All persons 65 or over who qualify for Social Security benefits, and some
people under 65 who are disabled, are eligible for Medicare -- a health
insurance program. To enroll in Medicare, telephone the local Social
Security Office three months before 65th birthday. Persons who work past
age 65 should apply for Medicare even if they are not applying for Social
Security benefits. Medicare has two parts:
Part A - Medical Hospital Insurance
Helps pay for medically necessary inpatient hospital care, and under limited
conditions may pay for some nursing home and home health care.
Part B - Medicare Medical Insurance
Helps pay for medically necessary physicians' services and other medical
services.
Qualified Medicare Beneficiary Program (QMB)
The Qualified Medicare Beneficiary Program, also known as the Medicare
Buy-In or "QMB," is a benefit for low-income Medicare beneficiaries
wherein Medicaid covers the Medicare enrollee's share of certain premium,
deductible and co-payment costs. Generally, to qualify for the QMB
program, an individual must:
Be entitled to Medicare Hospital Insurance (Part A)
Have annual income at or below the national poverty guidelines
Have very limited resources (bank accounts, etc.)For further
information and an application, contact Nassau County Department
of Social Services at 571-4817.
Specified Low Income Medicare Beneficiary Program (SLIMB)
Under this program, state Medicaid programs are required to "buy-in"
or
pay only the Medicare Part B premiums of individuals who are entitled to
Medicare Part B and who:
Have income greater than 100 percent and less than 110 percent of
the poverty level
Have resources which do not exceed twice the Supplemental
Security Income (SSI) resource standards. For further information
and an application, contact Nassau County Department of Social
Services at 571-4817. Social Security, Supplemental Security
Income and Medicare benefits are subject to frequent changes.
Health Maintenance Organizations (HMOs) for Medicare Beneficiaries
HMOs are managed care plans, and are also known as coordinated care
plans. A Medicare HMO is an organized, community-based network of
physicians, health centers, hospitals and other health care providers that is
approved by Medicare. HMOs differ from other kinds of health insurance
since they combine insurance coverage with provision of care. HMO
participants continue to pay the Part B premium, and, in most cases, the
HMO charges a premium. HMOs differ, but most provide benefits such as
preventive care, dental care, eyeglasses, etc. They also handle Medicare
paperwork, HMOs contract with different doctors and hospitals, and charge
different premiums. The New York State Office for the Aging has
published a booklet "Choosing an HMO, a Guide for Medicare
Beneficiaries." To obtain a copy call toll-free: 1-800-342-9871.
INSURANCE
Medicare Supplementary Insurance
Medicare Supplementary Insurance (Medigap Insurance) is designed to help
cover the deductible and co-payment gaps in Medicare coverage. Federal
and State regulations have established minimum standards for insurance
companies offering Medigap insurance. The New York State Insurance
Department has prepared a consumer guide, "Medicare Supplementary
Insurance in New York State." To obtain a copy contact:
New York State Insurance Department
Research Bureau 1-212-602-0638
160 West Broadway
New York, N.Y. 10013
Long-term Care Insurance
Insurance covering long term care services is sold by a number of private
insurance companies in New York State. It is available both on an
individual and a group basis. Before purchasing Long Term Care insurance
it is very important to determine exactly what services are covered,
including skilled and/or custodial care both in a nursing home at home.
Policies should be carefully read and compared. The New York State
Insurance Department has published a book "Insurance Policies Covering
Long Term Care in New York." A copy may be ordered from the address
and/or telephone number provided above.
Health Insurance Counseling
Family Service Association Senior Financial Counseling Program to
provides information and guidance to Nassau County seniors who request
assistance with health insurance selection and/or problems. For further
information call: 485-4600
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This page was last edited on Friday, January 11, 2002
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Copyright © 2001 Town of North Hempstead
Results from search: http://www.slcoagingservices.org/html/volhiip.html
Salt Lake County Aging Services - Health Insurance and
Information Program
HEALTH INSURANCE AND INFORMATION
PROGRAM
Other
Volunteer Program
(801) 468-2443
E-Mail: shaselton@co.slc.ut.us
Description:
The Health
Insurance Information Program (HIIP) volunteers go to the homes of people on
Medicare and help sort out provider statements, Medicare statements, and
supplementary insurance statements. Information is also provided to people
getting ready to go on the Medicare system. Volunteers also provide assistance
at different Health Fairs with booth personnel support, and some presentations
to give information about Medicare and supplementary insurance.
Volunteer
Opportunities
:
1. HIIP Counselor
Requirements:
Ability to read
Interest in Medicare, Medicaid, and
supplementary insurance
Ability to work with providers
Provide own transportation
Provide monthly reports
Personal background free from theft or violent
behavior
Commitment:
2 - 4
hours per month
Yearly
3 day training
2. Office Support
Requirements:
Enjoy talking with people, both walk in
customers and telephone customers
Basic computer skills
Ability to read
Commitment:
2 - 4 hours
during office hours weekly
Yearly 3 day
training
Training &
Support:
A yearly 3 day
training is provided to learn about Medicare, Medicaid, Long Term Care
Insurance, and supplementary insurance. Speakers from the Veterans Associan,
Social Security and Health Insight are also brought in. A quarterly Inservice
Training is also provided. Staff members also provide assistance, along with the
Volunteer Coordinator.
Contact person: Susanne
Haselton, 2001 South State Street, S1500, Salt Lake City, Utah 84190.
Telephone (801) 468-2433, Fax (801) 468-2852, E-Mail: shaselton@co.slc.ut.us
Alternatives Program
Bridges Volunteer Program
Caregiving
& Caregiver Support
English
as Second Language (ESL)
Experience
Corps
Foster
Grandparent Program
Health
Insurance Information Program
Healthy
Aging Program
Meals on
Wheels
Money
Management Program
Ombudsman
Program
Outreach
Program
RSVP
(Retired & Senior Volunteer Program)
Senior
Center Programs
Senior
Companion Program
Senior
Employment Program
Senior Transportation
Home
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Results from search: http://www.newstarthealth.org/application.pdf
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