Tricia Neuman, Sc.D. Director, Medicare Policy Project Vice President, Kaiser Family Foundation For KaiserEDU June 2009

1. Hello, I am Tricia Neuman, a vice president of the Kaiser Family Foundation, and director of the foundation�s Medicare policy work. In this tutorial, I�ll provide an overview of the Medicare program, and discuss the important role that Medicare plays for 45 million elderly and disabled Americans. I�ll also walk through the A, B, Cs and Ds of Medicare, and discuss some of the key fiscal and other PROGRAMMATIC challenges facing Medicare�s future. Hello, I am Tricia Neuman, a vice president of the Kaiser Family Foundation, and director of the foundation�s Medicare policy work. In this tutorial, I�ll provide an overview of the Medicare program, and discuss the important role that Medicare plays for 45 million elderly and disabled Americans. I�ll also walk through the A, B, Cs and Ds of Medicare, and discuss some of the key fiscal and other PROGRAMMATIC challenges facing Medicare�s future.

2. Medicare Overview 1965: Signed into law by President Johnson to provide health and economic security to seniors 1972: expanded to cover younger adults with permanent disabilities 2009: covers 45 million people, including 7 million under-65 disabled Covers individuals without regard to income or medical history Helps pay for range of medical services, including inpatient hospital, physician, home health, diagnostic tests and prescription drugs Medicare was established in 1965, at a time when nearly half of all seniors lacked health insurance. Signed into law by President Johnson, Medicare has emerged as a critical source of retirement security, along with Social Security. Medicare was expanded in 1972 to cover younger beneficiaries with permanent disabilities. To qualify, individuals must also be eligible for Social Security Disability Insurance payments, and must be on disability for 24 months before they are eligible for Medicare. Today, Medicare covers an estimated 45 million people including 7 million beneficiaries who are under age 65 and permanently disabled. Unlike many other health programs, Medicare covers individuals without regard to their income or medical history. For people approaching their 65th birthday, who often have one or more chronic conditions, the fact that Medicare is available to individuals including those with pre-x conditions, is quite important. Medicare has four parts: A, B, C and D, and I will review the benefits provided under each part, and how these benefits are financed.Medicare was established in 1965, at a time when nearly half of all seniors lacked health insurance. Signed into law by President Johnson, Medicare has emerged as a critical source of retirement security, along with Social Security. Medicare was expanded in 1972 to cover younger beneficiaries with permanent disabilities. To qualify, individuals must also be eligible for Social Security Disability Insurance payments, and must be on disability for 24 months before they are eligible for Medicare. Today, Medicare covers an estimated 45 million people including 7 million beneficiaries who are under age 65 and permanently disabled. Unlike many other health programs, Medicare covers individuals without regard to their income or medical history. For people approaching their 65th birthday, who often have one or more chronic conditions, the fact that Medicare is available to individuals including those with pre-x conditions, is quite important. Medicare has four parts: A, B, C and D, and I will review the benefits provided under each part, and how these benefits are financed.

3. Medicare Covers a Population with Diverse Needs and Circumstances Medicare services a population with diverse needs and circumstances. As you can see from this exhibit, more than 40% have low incomes, below 200 percent of poverty � which for a widow is $20,800. More than one in three beneficiaries have three or more chronic conditions. More than one in four are in fair or poor health. Note too that about more than one in four -29%- has a cognitive impairment � a limitation which makes it difficult manage day to day health care decisions, or health insurance choices, or more routine activities, like paying bills or taking medications. Medicare services a population with diverse needs and circumstances. As you can see from this exhibit, more than 40% have low incomes, below 200 percent of poverty � which for a widow is $20,800. More than one in three beneficiaries have three or more chronic conditions. More than one in four are in fair or poor health. Note too that about more than one in four -29%- has a cognitive impairment � a limitation which makes it difficult manage day to day health care decisions, or health insurance choices, or more routine activities, like paying bills or taking medications.

4. Medicare Part A � Hospital Insurance Program Inpatient hospital, skilled nursing facility, home health, hospice $1,068 deductible for hospital inpatient in 2009 Individuals (and spouses) entitled to Part A after paying payroll taxes for 10+ years Mainly funded by payroll tax contributions (1.45 percent from employers/employees) Medicare Part B � Supplementary Medical Insurance Physician visits, outpatient, preventive services, home health $96.40 monthly premium in 2009; higher for beneficiaries with higher incomes $135 deductible; 20% coinsurance for physician visits and outpatient hospital services Medicare has four Parts: A, B, C and D. Part A is the Hospital Insurance program, which helps pay for inpatient hospital visits and for skilled nursing facility stays of up to 100 days, as well as home health care, and hospice care. Medicare charges a deductible before it begins paying for hospital stays, an amount just over $1,000 in 2009, and also charges for each day of an extended stay in a hospital or skilled nursing facility. Typically people become entitled to Part A after they or their spouse pay a payroll tax for at least 10 years - which is 1.45 percent for employees and 1.45 percent for employers.. Part B ,the Supplementary Medical Insurance program, is voluntary, but virtually all beneficiaries entitled to Part A are enrolled in Part B. Part B helps pay for physician visits, outpatient hospital services, lab work, and preventive services such as mammograms and flu shots. Most beneficiaries enrolled in Part B are required to pay a monthly premium, which is $96.40 in 2009. Beneficiaries with relatively high incomes (about $85,000 for individuals) pay a higher income-related premium, while those with very low incomes do not pay the premium if they qualify for Medicaid. Part B services are ALSO subject to a deductible and most require a coinsurance of 20 percent, WHICH MEANS THAT THEY MUST PAY FOR 20% OF SERVICES COVERED UNDER PART B. Medicare has four Parts: A, B, C and D. Part A is the Hospital Insurance program, which helps pay for inpatient hospital visits and for skilled nursing facility stays of up to 100 days, as well as home health care, and hospice care. Medicare charges a deductible before it begins paying for hospital stays, an amount just over $1,000 in 2009, and also charges for each day of an extended stay in a hospital or skilled nursing facility. Typically people become entitled to Part A after they or their spouse pay a payroll tax for at least 10 years - which is 1.45 percent for employees and 1.45 percent for employers.. Part B ,the Supplementary Medical Insurance program, is voluntary, but virtually all beneficiaries entitled to Part A are enrolled in Part B. Part B helps pay for physician visits, outpatient hospital services, lab work, and preventive services such as mammograms and flu shots. Most beneficiaries enrolled in Part B are required to pay a monthly premium, which is $96.40 in 2009. Beneficiaries with relatively high incomes (about $85,000 for individuals) pay a higher income-related premium, while those with very low incomes do not pay the premium if they qualify for Medicaid. Part B services are ALSO subject to a deductible and most require a coinsurance of 20 percent, WHICH MEANS THAT THEY MUST PAY FOR 20% OF SERVICES COVERED UNDER PART B.

5. Beneficiaries can enroll in regular fee-for-service program OR in a Medicare Advantage (MA) plan MA include HMOs, PPOs and other private health plans Some plans offer extra benefits and have lower cost-sharing requirements than traditional Medicare Access to doctors and other health care providers is typically limited to those in the plan�s network Plans are paid a fixed amount per enrollee On average, 14 percent more than it would pay under traditional Medicare This extra payment will increase overall costs to Medicare by about~$150 b over 10 years Part C refers to the part of the Medicare program that allows Medicare beneficiaries to receive their Medicare-covered benefits through private plans, rather than through the traditional fee-for-service program. Today, Medicare beneficiaries have the option to enroll in a number of different types of plans for their Medicare covered benefits, including HMOs, PPOs, and private fee-for service plans. Nearly a quarter of all Medicare beneficiaries are enrolled in a Medicare Advantage plan, mainly HMOs. These plans contract with Medicare and receive payments from the government to provide benefits to enrollees. Over time, the methodology for determining how much the federal government will pay has evolved to encourage plan participation and provide extra benefits, particularly in rural areas. As a result, however, the federal government is now paying more for people who enroll in Medicare Advantage plans � 14 percent more on average � than it would pay for the same individuals if they were covered under Original Medicare. These so-called �overpayments� allow plans to provide extra benefits to the minority of beneficiaries who are enrolled in private plans, but increases costs to the federal government, at a time when the program is facing fiscal challenges. Part C refers to the part of the Medicare program that allows Medicare beneficiaries to receive their Medicare-covered benefits through private plans, rather than through the traditional fee-for-service program. Today, Medicare beneficiaries have the option to enroll in a number of different types of plans for their Medicare covered benefits, including HMOs, PPOs, and private fee-for service plans. Nearly a quarter of all Medicare beneficiaries are enrolled in a Medicare Advantage plan, mainly HMOs. These plans contract with Medicare and receive payments from the government to provide benefits to enrollees. Over time, the methodology for determining how much the federal government will pay has evolved to encourage plan participation and provide extra benefits, particularly in rural areas. As a result, however, the federal government is now paying more for people who enroll in Medicare Advantage plans � 14 percent more on average � than it would pay for the same individuals if they were covered under Original Medicare. These so-called �overpayments� allow plans to provide extra benefits to the minority of beneficiaries who are enrolled in private plans, but increases costs to the federal government, at a time when the program is facing fiscal challenges.

6. Medicare Prescription Drug Benefit (Part D) Part D is the outpatient prescription drug benefit, created under the Medicare Modernization Act of 2003, and implemented in 2006. The drug benefit differs from all other Medicare-covered benefits because it is the only benefit that is not provided directly under the traditional program. Beneficiaries can get the new Medicare drug benefit only if they are enrolled in private plans that contract with Medicare. These include stand-alone prescription drug plans and Medicare Advantage plans. Today, 90 percent of all Medicare beneficiaries have drug coverage. More than half of all Medicare beneficiaries just over half have drug coverage from a Medicare Part D plan. About a quarter still rely on employer plans for their drug coverage - mainly through retiree health plans - and about 6 million get drug coverage from other sources, such as the VA or Medigap policies. Still about 4 AND A HALF million Medicare beneficiaries are without drug coverage.. And coverage rates have not improved appreciably since 2006 WHEN THE PROGRAM WAS FIRST IMPLEMENTED. In virtually every state, beneficiaries can choose from among about 50 stand-alone prescription drug plans and many are also offered drug coverage under Medicare Advantage plans. Drug coverage under Part D plans varies widely - in terms of premiums, deductibles and cost-sharing, and most plans have a gap in coverage, known as the �doughnut hole�. The Part D benefit includes substantial subsidies for individuals with low incomes and FEW assets. These subsidies reduce or eliminate premiums and cost-sharing requirements, helping to make the benefit more affordable to beneficiaries living on fixed incomes. Part D is the outpatient prescription drug benefit, created under the Medicare Modernization Act of 2003, and implemented in 2006. The drug benefit differs from all other Medicare-covered benefits because it is the only benefit that is not provided directly under the traditional program. Beneficiaries can get the new Medicare drug benefit only if they are enrolled in private plans that contract with Medicare. These include stand-alone prescription drug plans and Medicare Advantage plans. Today, 90 percent of all Medicare beneficiaries have drug coverage. More than half of all Medicare beneficiaries just over half have drug coverage from a Medicare Part D plan. About a quarter still rely on employer plans for their drug coverage - mainly through retiree health plans - and about 6 million get drug coverage from other sources, such as the VA or Medigap policies. Still about 4 AND A HALF million Medicare beneficiaries are without drug coverage.. And coverage rates have not improved appreciably since 2006 WHEN THE PROGRAM WAS FIRST IMPLEMENTED. In virtually every state, beneficiaries can choose from among about 50 stand-alone prescription drug plans and many are also offered drug coverage under Medicare Advantage plans. Drug coverage under Part D plans varies widely - in terms of premiums, deductibles and cost-sharing, and most plans have a gap in coverage, known as the �doughnut hole�. The Part D benefit includes substantial subsidies for individuals with low incomes and FEW assets. These subsidies reduce or eliminate premiums and cost-sharing requirements, helping to make the benefit more affordable to beneficiaries living on fixed incomes.

7. Medicare Benefit Payments, by Type of Service, 2009 The four parts of Medicare now total nearly $500 billion. Inpatient hospital care accounts for the largest share, consuming about a quarter of all Medicare dollars. Physicicians account for 19 percent. Note that payments to Medicare advantage plans are now nearly a quarter of total benefit payments. Also note the Medicare drug benefit,that went into effect in 2006, now accounts for about a tenth of Medicare benefit spending.The four parts of Medicare now total nearly $500 billion. Inpatient hospital care accounts for the largest share, consuming about a quarter of all Medicare dollars. Physicicians account for 19 percent. Note that payments to Medicare advantage plans are now nearly a quarter of total benefit payments. Also note the Medicare drug benefit,that went into effect in 2006, now accounts for about a tenth of Medicare benefit spending.

8. Sources of Medicare Revenue in 2010 Medicare financing also varies across Parts A, B and D. Part A is funded mainly by the payroll tax that workers and employers pay. Part B is funded by general revenues - and by premiums paid by enrollees Part C is not separately financed, because it is simply a vehicle for delivering benefits covered under Parts A, B and D. Financing for Part D is simIliar to the financing of Part B, Part D is funded by general revenues, beneficiary premiums and payments from states on behalf of dual eligibles, THOSE WHO HAVE BOTH MEDICARE AND MEDICAID COVERAGE.Medicare financing also varies across Parts A, B and D. Part A is funded mainly by the payroll tax that workers and employers pay. Part B is funded by general revenues - and by premiums paid by enrollees Part C is not separately financed, because it is simply a vehicle for delivering benefits covered under Parts A, B and D. Financing for Part D is simIliar to the financing of Part B, Part D is funded by general revenues, beneficiary premiums and payments from states on behalf of dual eligibles, THOSE WHO HAVE BOTH MEDICARE AND MEDICAID COVERAGE.

9. Medicare offers important coverage, but with high cost-sharing and benefit gaps Does not cover all medical benefits Very limited long-term care coverage No dental, hearing aids or eyeglasses Has relatively high cost-sharing requirements Deductibles for Part A, Part B, and Part D Coinsurance/copayments Part D coverage gap (�doughnut hole�) No limit on out-of-pocket spending Unlike typical plans offered by large employer Pays about half of beneficiaries� total health and long-term care spending Thus far, we�ve focused on coverage under Medicare and how the benefits are financed. It is also important to note that Medicare still has significant gaps in coverage and relatively high cost-sharing requirements, which requires beneficiaries to absorb relatively high oop costs. While Medicare provides basic benefits, and now helps pay for prescription drugs, it does not pay for long-term care. Medicare has a limited skilled nursing facility benefit of up to 100 days and home health benefits, but does not pay for ongoing care for people with LTC needs, either in nursing homes, assisted living facilities or at home. Medicare does not pay for dental care, which can be quite expensive, and does not cover hearing aids or eyeglasses Further, Medicare has relatively high cost-sharing requirements WHEN THE DEDUCTIBLES AND OTHER COSTSHARING ARE CONSIDERED. And unlike typical large employer plans, Medicare�s drug benefit has a coverage gap (TN: I THINK YOU NEED TO EXPLAIN THE DONUT HOLE IN A BIT MORE DETAIL), and Medicare does not have a cap on catastrophic out-of-pocket expenses for covered benefits. Thus most beneficiaries NEED AND have some sort of supplemental coverage to help fill in the gaps and cover cost-sharing requirements. Thus far, we�ve focused on coverage under Medicare and how the benefits are financed. It is also important to note that Medicare still has significant gaps in coverage and relatively high cost-sharing requirements, which requires beneficiaries to absorb relatively high oop costs. While Medicare provides basic benefits, and now helps pay for prescription drugs, it does not pay for long-term care. Medicare has a limited skilled nursing facility benefit of up to 100 days and home health benefits, but does not pay for ongoing care for people with LTC needs, either in nursing homes, assisted living facilities or at home. Medicare does not pay for dental care, which can be quite expensive, and does not cover hearing aids or eyeglasses Further, Medicare has relatively high cost-sharing requirements WHEN THE DEDUCTIBLES AND OTHER COSTSHARING ARE CONSIDERED. And unlike typical large employer plans, Medicare�s drug benefit has a coverage gap (TN: I THINK YOU NEED TO EXPLAIN THE DONUT HOLE IN A BIT MORE DETAIL), and Medicare does not have a cap on catastrophic out-of-pocket expenses for covered benefits. Thus most beneficiaries NEED AND have some sort of supplemental coverage to help fill in the gaps and cover cost-sharing requirements.

10. Supplemental Coverage Among Medicare Beneficiaries, by Income, 2006 Most beneficiaries have some form of supplemental coverage � but sources of supplemental coverage vary significantly by beneficiaries� income. Medicaid is critical source of supplemental coverage for half (52 percent) of Medicare beneficiaries with the lowest incomes ($10,000 or less), while employer-sponsored coverage is the primary source of supplemental coverage for beneficiaries with the highest incomes (more than $40,000), covering 59 percent of this group. Overall, nearly 10 percent of Medicare beneficiaries lack supplemental coverage from any source. This group is at greatest risk for going without needed care due to high-cost-sharing requirements, or bearing a signficiant financial burden paying for their medical care. Most beneficiaries have some form of supplemental coverage � but sources of supplemental coverage vary significantly by beneficiaries� income. Medicaid is critical source of supplemental coverage for half (52 percent) of Medicare beneficiaries with the lowest incomes ($10,000 or less), while employer-sponsored coverage is the primary source of supplemental coverage for beneficiaries with the highest incomes (more than $40,000), covering 59 percent of this group. Overall, nearly 10 percent of Medicare beneficiaries lack supplemental coverage from any source. This group is at greatest risk for going without needed care due to high-cost-sharing requirements, or bearing a signficiant financial burden paying for their medical care.

11. Median out-of-pocket health spending as a percent of income for Medicare beneficiaries is on the rise � especially for those with modest incomes As you can see here, Medicare beneficiaries are spending a larger and larger share of their income for health care. This is because health costs are rising faster than income. Median out-of-pocket spending as a share of income increased from 11.9 percent in 1997 to 16.1 percent in 2005, including a statistically significant increase between 2004 and 2005. The increasing financial burden of health care is steepest for those with modest incomes. In some respects, the median does not tell a story, because it minimizes the impact on those with the greatest burden. In 2005, the 25 percent of beneficiaries with the largest burden spent nearly one-third or more (30.7 percent) of their income on health care, suggesting that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries. As you can see here, Medicare beneficiaries are spending a larger and larger share of their income for health care. This is because health costs are rising faster than income. Median out-of-pocket spending as a share of income increased from 11.9 percent in 1997 to 16.1 percent in 2005, including a statistically significant increase between 2004 and 2005. The increasing financial burden of health care is steepest for those with modest incomes. In some respects, the median does not tell a story, because it minimizes the impact on those with the greatest burden. In 2005, the 25 percent of beneficiaries with the largest burden spent nearly one-third or more (30.7 percent) of their income on health care, suggesting that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries.

12. Looking to the future, Medicare beneficiaries can expect to see sustained increases in premiums and out-of-pocket expenses, according to the most recent projections of the Medicare and Social Security Trustees. For example, between 2009 and 2018, The Part A deductible is projected to increase by nearly 50 percent. Part B premiums are expected to increase by about 36 percent. And, the Part D doughnut hole is expected to widen by nearly two thirds. During this same period of time, average Social Security checks are projected to rise more slowly - by just _______ percent , which means health costs will likely consume a larger share of seniors incomes over time, unless changes are made to slow the growth in health spending, or provide greater financial protections to people covered under Medicare. Looking to the future, Medicare beneficiaries can expect to see sustained increases in premiums and out-of-pocket expenses, according to the most recent projections of the Medicare and Social Security Trustees. For example, between 2009 and 2018, The Part A deductible is projected to increase by nearly 50 percent. Part B premiums are expected to increase by about 36 percent. And, the Part D doughnut hole is expected to widen by nearly two thirds. During this same period of time, average Social Security checks are projected to rise more slowly - by just _______ percent , which means health costs will likely consume a larger share of seniors incomes over time, unless changes are made to slow the growth in health spending, or provide greater financial protections to people covered under Medicare.

13. Medicare Spending and Financing I�d now like to shift gears, and quickly talk about Medicare within the context of the health care system generally and within the federal budget and review some of the fiscal challenges facing Medicare mainly due to the unrelenting increase in health care costs, affecting all payers, including Medicare.I�d now like to shift gears, and quickly talk about Medicare within the context of the health care system generally and within the federal budget and review some of the fiscal challenges facing Medicare mainly due to the unrelenting increase in health care costs, affecting all payers, including Medicare.

14. Medicare accounts for 13% of federal spending and 22% of national health spending Medicare is now 13 percent of the federal budget and 22 percent of national health expenditures. Medicare is thus critical to ongoing discussions about reforming the health care system, and obviously important to discussions about federal spending. Together Medicare and Social Security account for a third of all federal spending - a share projected to increase with the aging of the bb generation and with rising health costs.Medicare is now 13 percent of the federal budget and 22 percent of national health expenditures. Medicare is thus critical to ongoing discussions about reforming the health care system, and obviously important to discussions about federal spending. Together Medicare and Social Security account for a third of all federal spending - a share projected to increase with the aging of the bb generation and with rising health costs.

15. A small share of beneficiaries account for most of Medicare spending In thinking about Medicare spending, and ways to control the growth in spending over time, a key consideration is that spending is highly skewed. As in other health programs and plans, a small share of beneficiaries (ADD �WHO OFTEN HAVE VERY COMPLICATED HEALTH PROBLEMS OR AT THE END OF THEIR LIFE� ?) account for a large share of spending. Medicare spending for the top ten percent of all Medicare beneficiaries averaged about $44,000, while spending for the vast majority of beneficiaries was considerably lower.. Just under $3,000, or less than one tenth of the high spenders. A serious challenge for policymakers is finding ways to pull down costs for high spenders, and there is growing interest in changes that could , for example, prevent unnecessary and costly hospital re-admissions and do a better job coordinating care for high-cost chronically ill patients.In thinking about Medicare spending, and ways to control the growth in spending over time, a key consideration is that spending is highly skewed. As in other health programs and plans, a small share of beneficiaries (ADD �WHO OFTEN HAVE VERY COMPLICATED HEALTH PROBLEMS OR AT THE END OF THEIR LIFE� ?) account for a large share of spending. Medicare spending for the top ten percent of all Medicare beneficiaries averaged about $44,000, while spending for the vast majority of beneficiaries was considerably lower.. Just under $3,000, or less than one tenth of the high spenders. A serious challenge for policymakers is finding ways to pull down costs for high spenders, and there is growing interest in changes that could , for example, prevent unnecessary and costly hospital re-admissions and do a better job coordinating care for high-cost chronically ill patients.

16. Medicare Financial Challenges Part A Trust Fund - The hospital insurance trust fund is projected to be insolvent by 2017 � with insufficient funds to pay for all promised benefits Worker to retiree ratio � The number of workers per beneficiary is projected to decline as the Medicare population grows in the future GDP � Medicare spending is projected to double from 3.5% of GDP in 2010 to 6.4% of GDP by 2030. The Congressional Budget Office indicates most of the growth is due to rising health costs, rather than the aging of the Baby Boom generation. Given projected increases in health costs, and an aging population, it is not a surprise that the Medicare Trustees suggest that Medicare faces serious financial challenges. According to a report in 2009 from the Medicare actuaries WHO TRACK MEDICARE SPENDING, spending on Part A benefits exceeds the revenues coming in FROM PAYROLL TAXES, so Medicare will now need to rely on reserves that have been built up over the years in the Part A trust fund, which is the account used to pay for hospital benefits, in order to fully pay for these benefits. The actuaries also projected that these reserve funds will be fully depleted in 2017, meaning there will be insufficient funds to pay for all benefits that year - unless Congress takes action as it has in the past to slow spending or increase revenues. (NEED TO MENTION THE WORKER TO RETIREE RATIO, I MOVED UP TO INCLUDE UNDER PART A BUT IT IS A BROADER ISSUE, RIGHT? The actuaries also point out that Medicare is projected to consume a growing share of the gross domestic product as well as consume a larger share of national health expenditures. Significantly, the Congressional Budget Office indicates most of the growth is due to rising health costs, rather than the aging of the babyboom generation. This analysis has helped to reframe the debate about Medicare spending, shifting the emphasis away from viewing Medicare as a program that is �broken� and in need of fundamental reform to a program that is being hammered by rising health care costs � much the same as other payers. (TN: AREN�T THE LAST 2 BULLETS THE SAME POINT?) Given projected increases in health costs, and an aging population, it is not a surprise that the Medicare Trustees suggest that Medicare faces serious financial challenges. According to a report in 2009 from the Medicare actuaries WHO TRACK MEDICARE SPENDING, spending on Part A benefits exceeds the revenues coming in FROM PAYROLL TAXES, so Medicare will now need to rely on reserves that have been built up over the years in the Part A trust fund, which is the account used to pay for hospital benefits, in order to fully pay for these benefits. The actuaries also projected that these reserve funds will be fully depleted in 2017, meaning there will be insufficient funds to pay for all benefits that year - unless Congress takes action as it has in the past to slow spending or increase revenues. (NEED TO MENTION THE WORKER TO RETIREE RATIO, I MOVED UP TO INCLUDE UNDER PART A BUT IT IS A BROADER ISSUE, RIGHT? The actuaries also point out that Medicare is projected to consume a growing share of the gross domestic product as well as consume a larger share of national health expenditures. Significantly, the Congressional Budget Office indicates most of the growth is due to rising health costs, rather than the aging of the babyboom generation. This analysis has helped to reframe the debate about Medicare spending, shifting the emphasis away from viewing Medicare as a program that is �broken� and in need of fundamental reform to a program that is being hammered by rising health care costs � much the same as other payers. (TN: AREN�T THE LAST 2 BULLETS THE SAME POINT?)

17. Looking to the Future� Medicare remains critical source of health coverage and economic security for many Addressing fiscal pressures without shifting more costs to beneficiaries Setting fair payment rates to providers and plans Monitoring and improving Part D drug benefit Assessing role of Medicare Advantage plans Improving care to meet needs of those with coverage and chronic illnesses and disabilities Ensuring affordability for lower-income beneficiaries Strengthening coverage for long-term care services .. Thank you.  (WE TYPICALLY HAVE A FINAL SLIDE WITH RESOURCES FOR MORE INFO. I�LL PUT .. Thank you. (WE TYPICALLY HAVE A FINAL SLIDE WITH RESOURCES FOR MORE INFO. I�LL PUT

18. Kaiser Family Foundation�s Medicare Policy Project kff.org/medicare/index.cfm Official Medicare site medicare.gov/ Centers for Medicare & Medicaid Services (CMS) cms.hhs.gov Congressional Budget Office (CBO) cbo.gov Medicare Payment Advisory Commission (MedPAC) medpac.gov (WE TYPICALLY HAVE A FINAL SLIDE WITH RESOURCES FOR MORE INFO. If you�d like to learn more about Medicare, please be sure to check these resources. Thank you! (WE TYPICALLY HAVE A FINAL SLIDE WITH RESOURCES FOR MORE INFO. If you�d like to learn more about Medicare, please be sure to check these resources. Thank you!