Simon's Medicare Part C plan - Senator Paul Simon - Brief Article

Healthcare Financial Management, Nov, 1991

Sen. Paul Simon (D-Ill.) is developing legislation that would create a new Medicare Part C to provide comprehensive LTC coverage to the elderly, working age individuals, and children. Lower-income individuals would continue to be covered by Medicaid.

Under Simon's "Long-term Care Family Insurance Act," Medicare would pay up to $2,400 per month for nursing facility services. Beneficiaries would be liable for a $500 per month copayment. LTC patients would become eligible for coverage after receiving 90 days of nursing home care. The bill includes no limit on length of coverage.

Individuals would be eligible for nursing home benefits if they needed assistance in three or more activities of daily living (ADLs). For home care, the threshold would be two or more ADLs. Home care would be available for chronically ill children or persons dependent on medical technology. Disabled individuals could "buy in" to Medicare's long-term care benefits.

New benefits would be financed by a 0.5 percent increase in both employer and employee Social Security taxes and by eliminating the $125,00 cap on income subject to the Medicare payroll tax.