02: Medicaid and Medicare Flashcards
What are the four modes of payment for healthcare payment and reimbursement?
- Out of pocket
- Idividual private insurance
- Employment-based group private insurance
- Government financing
Which of the following is NOT a government financing option?
A. Medicaid
B. Medicare
C. ACA Exchanges
D. Veteran’s Administration
C
Title XVIII of the Social Security Act of 1965…
A. Decreased penalty for not buying insurance
B. Established a program to provide medical services for people receiving cash assistance or welfare
C. Increased Medicaid reimbursement
D. Allowed dependents to be on parents’ insurance until age 26
B
This program was called MEDICAID!
Medicaid expanded over time to include/cover all but which of the following?
A. Infants and children
B. Poor adults without dependents
C. Pregnant women
D. Individuals with mental or physical disabilities
B
One of the greatest assets of the Balanced Budget Act of 1997 was the establishment of:
A. Children’s Health Insurance Program (CHIP)
B. Medicaid
C. ACA Exchanges
D. None of the above
A
True or false: CHIP provides coverage for US citizen children only up to age 19 who are not eligible for Medicaid.
False
Includes immigrant children as well.
Which of the following is a role of Medicaid and CHIP?
A. Filling large gaps in health insurance coverage
B. Assistance to Medicare beneficiaries
C. Long-term services and support (LTSS)
D. Safety net
E. A and C
F. All of the above
F
The Healthcare and Education Reconciliation Act amended the original Patient Protection and Affordable Care Act of 2010. Which of the following is FALSE about this act?
A. Increased penalty for not buying health insurance
B. Increased Medicaid reimbursement
C. Provided more generous subsidies to low-income groups
D. Penalized companies of 50+ employees that did not offer health insurance
A
The penalty for not buying health insurance was DECREASED.
Title 1 federally prohibits denying coverage based on pre-existing conditions, dropping coverage if a patient falls ill, and extends dependent coverage to age 26.
What Act is Title 1 a part of?
A. Social Security Act
B. CHIP
C. Affordable Care Act
C
True or false: Title 2 of the Affordable Care Act prohibits denying coverage based on pre-existing conditions, dropping coverage if a patient falls ill, extends dependent coverage to age 26, and provides tax subsidies to individuals up to 400% of the federal poverty level.
False
What is described is Title 1. Title 2 refers to the Medicaid expansion to 138% of poverty level and simplified CHIP enrollment.
Who was left out of Medicaid coverage AFTER reform?
A. All adults above 100% federal poverty level
B. Adults without dependent children
C. Those who lost coverage during renewal time
D. Undocumented immigrants (less than 5 years)
D
True or false: The federal government matches at least 50 percent of Medicaid per state.
True
It is based on each states capita income.
True or false: While Medicaid is offered in every state, it is voluntary.
True
True or false: Medicaid is a government-run healthcare delivery system.
False
States pay physicians, hospitals and other providers for Medicare beneficiaries.
Medicaid offers 4 ways to manage costs. Which of the following is not a way Medicaid conserves costs?
A. Fee-for-service (FFS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
E. Managed Long-Term Services and Supports (MLTSS)
A
The following describes which Medicaid cost conservation program?
Capitation based; states pay a premium per person in exchange for comprehensive benefits.
A. Managed Long-Term Services and Supports (MLTSS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
B
The following describes which Medicaid cost conservation program?
A Medicaid-managed care program covering institutionalization, home care, and community-based long-term care.
A. Managed Long-Term Services and Supports (MLTSS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
A
The following describes which Medicaid cost conservation program?
A non-comprehensive Medicaid program that pays for certain services only; generally either outpatient (PAHP) or inpatient (PIHP)
A. Managed Long-Term Services and Supports (MLTSS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
D
The following describes which Medicaid cost conservation program?
States pay primary care physicians to help provide case management services. A small monthly case management fee and sometimes fee-for-service is paid.
A. Managed Long-Term Services and Supports (MLTSS)
B. Managed Care Organization (MCO)
C. Primary Care Case Management (PCCM)
D. Prepaid Health Plan (PHP)
C
All but which of the following are covered under Medicaid?
A. Labs
B. Transportation
C. Family planning services and supplies
D. Hospice services
D
True or false: Medicaid covers compression garments for lymphedema.
True
True or false: Medicaid does not cover durable medical equipment while Medicare does.
False
Medicaid DOES not cover durable medical equipment while Medicare does NOT.
Enrollment in Medicaid does NOT depend on:
A. Poverty rates/income
B. Age
C. Strength of the state’s economy
D. Medical price inflation
B
Medicaid Section 1115 demonstration waivers allows…
A. States to exclude mental health benefits
B. States to require fee-for-service
C. States to test new approaches in Medicaid
D. States to defund CHIP
C
How did the government believe the repeal of the penalty for the individual mandate would affect health care?
A. Decrease in enrollment by the millions
B. Increase in premiums
C. Decrease in state participation in Medicaid
D. A and B
E. All of the above
D
True or false: People with disabilities may still qualify for Medicaid even if their income is higher than the poverty level.
True
Examples of durable medical equipment covered by Medicaid include all but which of the following?
A. Tub bench
B. Hoyer lift
C. Raised toilet seat
D. Rolling commode
D
Rolling commodes are NOT covered, however, stationary commodes ARE covered.
True or false: Medicaid covers home modifications such as elevators and stair lifts.
False
True or false: Medicaid will cover an unlocked iPad as a communication device.
False
The iPad can only be used for communication and generally would require payment to be unlocked.
True or false: Medicaid requires a letter of medical necessity for power mobility devices.
True
In 1965, Title XVIII of the Social Security Act…
A. Added the role of private health plans to Medicare in the Medicare Modernization Act (MMA)
B. Established Medicare to provide health insurance to people over 65
C. Expanded Medicare to include people under 65 with permanent disabilities
D. Expanded Medicare eligibility to cover ALS
B
In 1972, Title XVIII of the Social Security Act…
A. Added the role of private health plans to Medicare in the Medicare Modernization Act (MMA)
B. Established Medicare to provide health insurance to people over 65
C. Expanded Medicare to include people under 65 with permanent disabilities
D. Expanded Medicare eligibility to cover ALS
C
In 2001, Title XVIII of the Social Security Act…
A. Added the role of private health plans to Medicare in the Medicare Modernization Act (MMA)
B. Established Medicare to provide health insurance to people over 65
C. Expanded Medicare to include people under 65 with permanent disabilities
D. Expanded Medicare eligibility to cover ALS
D
In 2003, Title XVIII of the Social Security Act…
A. Added the role of private health plans to Medicare in the Medicare Modernization Act (MMA)
B. Established Medicare to provide health insurance to people over 65
C. Expanded Medicare to include people under 65 with permanent disabilities
D. Expanded Medicare eligibility to cover ALS
A
True or false: The difference between SSDI and SSI is that SSI pays benefits to adults and children with limited income whereas SSDI pays benefits for disability based on more regulations.
True
True or false: Medicare is expected to decrease as baby boomers age out.
False
The US Population is expected to triple between 2010 and 2050 from 11 million to 31 million.
Medicare Part A is described as…
A. Prescription drug coverage
B. Medical insurance
C. Medicare Advantage (“all-in-one alternative”)
D. Hospital insurance
D
Medicare Part B is described as…
A. Prescription drug coverage
B. Medical insurance
C. Medicare Advantage (“all-in-one alternative”)
D. Hospital insurance
B
Medicare Part C is described as…
A. Prescription drug coverage
B. Medical insurance
C. Medicare Advantage (“all-in-one alternative”)
D. Hospital insurance
C
Medicare Part D is described as…
A. Prescription drug coverage
B. Medical insurance
C. Medicare Advantage (“all-in-one alternative”)
D. Hospital insurance
A
True or false: When people refer to the “original Medicare” they are referring to Medicare Part A.
False
“Original Medicare” refers to Medicare Part A and Part B.
Eligibility for Medicare Part A includes all of the following EXCEPT:
A. Anyone over the age of 65
B. People under the age of 65 with permanent disabilities
C. People with ESRD
D. People with ALS
A
Specifically, people over 65 who are permanent residents for at least 5 years or US Citizens.
True or false: Under Medicare, once a patient is admitted, every 60 days counts as a benefit period and the patient must pay a deductible.
True
True or false: Under Medicare, a patient must be hospitalized under observation status for 3 days before Medicare will cover rehab.
False
A patient must be formally admitted for at least 3 days before Medicare will cover rehab.
How many Lifetime Reserve Days is each individual given under Medicare?
A. 60
B. 90
C. 120
D. 200
A
[Under Medicare] After Lifetime Reserve Days are used the patient…
A. Pays a daily copay
B. Continues to pay a deductible every 60 days
C. Pays the full cost of care
D. is no longer responsible for the costs of care
C
True or false: Under Medicare, anyone can be admitted to a Skilled Nursing Facility (SNF) with a referral from a doctor.
False
A patient must have had a minimum 3-consecutive-day stay at a hospital with a transfer to the SNF within 30 days of hospital discharge.
True or false: Inpatient mental health care is limited to 190 days during a patient’s lifetime.
True
True or False: A patient is automatically enrolled in Medicare Part B if enrolled in Part A, even though Medicare Part B is voluntary.
True
True or false: The premium for Medicare Part A and Part B are combined, but have separate deductibles.
False
Medicare Part B is a separate monthly premium ($164.90 per month in 2023). Deductibles are also separate.
What is the threshold for Occupational Therapy care under Medicare Part B (as of 2023)?
A. $1500
B. $2150
C. $2000
D. $1750
B
True or false: You can enroll in Medicare Part C if you are ineligible for Part A or B.
False
You can only enroll in Part C if you are eligible for Part A and B.
True or false: Medicare Part C covers all benefits under Part A and B, includes extra benefits like eyeglasses, and in many cases, also Part D.
True
This voluntary program allows individuals to enroll in a private plan such as HMO or PPO.
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
C
MAPD and PDP are two types of which Medicare plan?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
D
MAPD: Medicare Advantage Prescription Drug
PDP: Standalone prescription drug plan supplemental to traditional Medicare
When the term “donut hole” is used in relation to Medicare Part D, what does it mean/refer to?
A. A coverage gap of 25%
B. Lack of catastrophic coverage
C. A $500 deductible, then patient pays 25%
A
Which of the following is a huge problem for Medicare Part D?
A. High deductibles
B. Therapy caps
C. Strict eligibility requirements
D. Gaps in coverage
D
Under Medicare, all of the following examples of Durable Medical Equipment (DME) are covered except:
A. Canes
B. Commodes
C. Tub bench
D. Hospital bed
C
Under Medicare, all of the following examples of Durable Medical Equipment (DME) are NOT covered except:
A. Tub bench
B. Power mobility used in the home
C. Grab bars
D. Raised toilet seats
B
True or false: Under Medicare, if a person can walk in-home with an assistive device safely, they do not qualify for a wheelchair.
True
