Medicare: From Historical Background to Current Milestones
Explore the evolution of Medicare from its historical roots to modern milestones, including the ABCD structure, Puerto Rico statistics, and the Traditional vs. Advantage options. Learn about key aspects like Hospital, Outpatient, and Pharmacy services, as well as the increasing number of beneficiaries over the years.
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Presentation Transcript
Medicare ABCD Presentation to the San Juan Rotary Club May 12, 2020 Marina Diaz, MHSA Centers for Medicare & Medicaid Services Puerto Rico & Virgin Islands
Presentation Structure Background: A Little Bit Of History Parts ABCD Medicare Then / Now Puerto Rico By The Numbers The Medicare Advantage Program New Technologies Blue Bottom My Medicare Plan Compare Puerto Rico State Insurance Assistance Appendix Detailed History
Historical Background 1965- Titles XVIII and XIX of the Social Security Act Signed into law by President Lyndon B Johnson Coverage for people 65 and older- MEDICARE Coverage for people at certain poverty level - Medicaid 1972- Extended to individuals under 65 with dissabilities 1977- Health Care Financing Administration(HCFA) 1982- Agency delegates payments of hospitals and creates the Quality Oversight
Medicare Milestones 2000- Benefits improvement Protection Act Increased Medicare payments to managed Health Care organizations 2001- Secretary Tommy Thompson change name from HCFA to Centers for Medicare and Medicaid Services 2003- Prescription Drug benefit: Foster competition among Health plan Impulse innovation Covered prevention services 2007- Beneficiaries with higher income were asked to pay greater share of part B
Then and Now Then and Now Number of Beneficiaries % of Federal Expenditure 1965 - 19 million 2.3% 2019 - 61 million 23.5%
ABCD of Medicare ABCD of Medicare A HOSPITAL SERVICES B OUTPATIENT SERVICES ( Not automatic in Puerto Rico) C MEDICARE ADVANTAGE D PHARMACY SERVICES
Puerto Rico 2019 Puerto Rico 2019 Medicare Beneficiaries - 745,471 Medicare Advantage (79.6%) - 593,337 New Beneficiaries Monthly - 1,000
Medicare Traditional and Medicare Advantage o There are two options to elect in Medicare: 1. Traditional Medicare An open network accepted by all providers who accept Medicare, OR 2. Medicare Advantage Organizations (MAO) which is a managed care plan through a specific carrier: o In Puerto Rico, there are 4 options of MAO carriers: a) Humana, b) MMM c) MCS d) Triple-S Categorized by a star rating (1-5) Open Enrollment - Oct 15-Dec 7 Jan 1-March 31st, -you can change plans or return to Traditional Medicare
Medicare Advantage VS. Traditional Medicare MA Traditional You should use the physicians in their network You go to any provider that accepts Medicare May need a referal from a primary physician to go to a specialist You go directly to any specialist Reduces out of pocket costs because it bundles pharmacy., Dental and Vision It covers 80% of costs, you need to buy supplemetary coverage and pharmacy coverage
eMedicare Efffort to improve the relationship between the beneficiary and Medicare with user friendly technology My Medicare-provides access to your information, re-print card, get your utilization report What is Covered; you know if a procedure or service is covered Plan Compare: tool designed to assist in decision making comparing the different Health plans benefit packages
State Health Insurance Assistance Program Staff is trained to provide coaching on comparing plans and deciding between traditional Medicare and Advantage San Juan Office is in Bus Stop 18- Santurce (Marshall s Blg) SHIP 1-877-725-4300
Puerto Rico/USVI Office Local Engagement and Administration: Obtain and Provide clarity on CMS Rules and Regulations Disseminate Information Bridge Conversations between PR Stakeholders and Subject Matter Experts Outreach and Education to providers and beneficiaries
Questions prfo@cms.hhs.gov Local Contact marina.diaz@cms.hhs.gov Medicare.gov 1-800-633-4227
Historical Background 1965- Titles XVIII and XIX of the Social Security Act Signed into law by President Lyndon B Johnson Coverage for people 65 and older- MEDICARE Coverage for people at certain poverty level - Medicaid 1972- Extended to individuals under 65 with dissabilities
Medicare Milestones 1980 s Medigap (supplemental coverage) under federal oversight Prospective payment system for hospitals 1997-Balanced Budget Act (BBA) Established a new array of Managed care and other private Health plan choices Need to slow rate of spending growth to extend life of trust fund Testing innovative models of payment
Medicare Milestones 2000- Benefits improvement Protection Act Increased Medicare payments to managed Health Care organizations 2001- Secretary Tommy Thompson change name from HCFA to Centers for Medicare and Medicaid Services 2003- Prescription Drug benefit: Foster competition among Health plan Impulse innovation Covered prevention services 2007- Beneficiaries with higher income were asked to pay greater share of part B
Medicare Milestones 2015- Alternative payment models-encourage quality and efficiency 2020- In response to pandemic: Expand telemedicine Increase workforce Hospital without walls Expand testing
