Lecture 5 Medicare and Other Social Insurance ProgramsMedicareMedicare BenefitsMedicare Part CSlide 5Unemployment InsuranceUnemployment Insurance - (cont.)Slide 8Temporary Disability LawsWorkers’ CompensationWorkers’ Compensation - (cont.)Slide 12Lecture 5Medicare and Other Social Insurance Programs•Medicare•Unemployment Insurance•Temporary Disability Laws•Workers’ CompensationMedicare•Eligibility–Retirees 65 or older–Dependents 65 or older of workers over 62–Survivors 65 or older–Disabled persons after 2 years of benefits–Workers, spouses or dependents for end-stage kidney disease•Anyone not eligible who is 65 or older can enroll voluntarily•Primary/secondary rulesMedicare Benefits•Part A–No cost (except for voluntary enrollment)–Hospital benefits–Skilled nursing facility benefits–Home health care benefits–Hospice benefits•Part B–Monthly premium ($45.50 for 1999)–Medical expenses not covered under Part A–Numerous exclusions–Deductible and coinsurance–Fee limitations on doctorsMedicare Part CMedicare+ChoiceBalanced Budget Act of 1997Voluntary alternatives to traditional MedicareMust be eligible for Parts A and B and elect to replace them with Part CReceive supplemental benefits7 million covered (17%)Medicare Part C3 Types of plans to choose fromCoordinated Care PlansProvider Sponsor OrganizationsMedicare+Choice MSAMedicare Risk HMOs eliminatedProvider receives a uniform capitation paymentAnnual open enrollment periodUnemployment Insurance•Benefits are taxable income to the recipient•Congress instituted this program in 1935•Objectives–Provide income to workers during temporary unemployment–Help unemployed find jobs–Encourage employers to stabilize employment–Maintain a stable labor supplyUnemployment Insurance - (cont.)•Financing of benefits–Federal tax: 0.8% of covered payroll–State tax: experience rated•Eligibility–Prior attachment to labor force–Able and available to work–Actively seeking work–Prescribed waiting period–Free of disqualification•Voluntarily leaving job•Discharged for misconduct•Labor disputeUnemployment Insurance - (cont.)•Benefits–Vary by state–Typically 50% of earnings–Maximum benefits range from $180 to $350/week–Paid for 26 weeks (can be extended by law in periods of high unemployment)Temporary Disability Laws•Apply in California, Hawaii, New Jersey, New York, Rhode Island and Puerto Rico•Covers nonoccupational disability•Eligibility–Employment requirement–Definition of disability–Waiting period•Benefits are taxable income to recipientWorkers’ Compensation•Benefits are tax free to the recipient•Each state has its own law•Eligibility–Covered occupation–Accidental occupational injuries arising out of and in the course of employment–Also coverage for occupational diseaseWorkers’ Compensation - (cont.)•Benefits–Medical care•No deductible, coinsurance or limits–Disability income•Approximately 2/3 coverage wages–Death benefits–Rehabilitative servicesWorkers’ Compensation - (cont.)•Problems–Extent of coverage–Adequacy of benefits–Increasing costs•Medical costs•Increased benefits•Expansion of coverage•Increased litigation•Fraud–Concept of 24-Hour