1 - Medicare: The Program Flashcards
4 parts of Medicare program:
- Part A: Hospital Insurance
- Part B: Medical Insurance
- Part C: Medicare Advantage
- Part D: Prescription Drug Plan
Medicare Part A
- Hospital Insurance Program (HI)
- inpatient hospital care, skilled nursing facility care, home health care and hospice care
Medicare Part B
- Medical Insurance program
- doctor’s services and medical supplies
- “doctor’s coverage”
Medicare Parts A & B are now often referred to as _____________. The two parts are referred to in the health insurance industry as __________.
- Original or Traditional Medicare
- Fee-for-service plans
Medicare Part C
- “Medicare Advantage”
- HMO and PPO
Medicare Part D
-Medicare Prescription Drug Program
All eligible individuals enrolling in Medicare Part B (Medical Insurance) will pay a current premium unless he or she qualifies for the _____________.
-Medicare Savings Program
The Medicare Savings Program in North Carolina is known as __________.
-Medicare-Aid
Individuals, age _____ and older, are eligible for all four (4) parts of the Medicare Program. The individual must be a United States citizen or permanent resident of the United States.
-65 years
Eligible individuals may enroll in the Medicare Program as early as ________ prior to his or her 65th birthday. Benefits begin on the first day of the _______ if the enrollee’s 65th birthday is any day other the first day of the month.
- 3 months prior
- birth month
An individual may qualify for Medicare benefits if he or she is under the age of _______ and is currently receiving Social Security disability benefits or Railroad Board (RRB) disability benefits and has been for the previous _________.
- 65
- 24 months
Medicare coverage for kidney related events ends _______ after the end of kidney dialysis or ______ months after a kidney transplant.
- 12 months
- 36 months
The Initial Enrollment Period (IEP) is the ________ prior to the eligible individual’s 65th birthday, the month of his or her birthday and the ________ after the month of his or her birthday.
- 3 months
- 3 months
An eligible individual cannot be rejected by Medicare due to a ______________. Also, there is _____ waiting period due to a pre-existing medical condition.
- pre-existing medical condition
- no waiting period
If an individual is not enrolled during the Initial Enrollment Period (IEP) for Medicare Parts A and B, he or she will have to wait until the next ___________).
- General Enrollment Period
- January 1st to March 31st
The General Enrollment Period (GEP) lasts from ________ to _________ annually.
- January 1st
- March 31st
Individuals who continue to work past age sixty-five (65) and are enrolled in a _______ employer group health plan or covered under their spouse’s qualified group health plan can delay enrollment (without a penalty) in Medicare Parts B and D until disenrollment or cancellation of coverage under the group health plan.
-“qualified”
A qualified group health plan is a plan that has at least ______ covered employees and would qualify under ______.
- 20
- COBRA
The Medicare Beneficiary may enroll in Medicare Part B after disenrolling from the qualified group major medical health plan if he or she worked past age _______ or was covered by the spouse’s group plan
-65
The Medicare Beneficiary will have a Special Enrollment Period of _______ from the date of disenrollment from the group plan to enroll in Medicare Part B without a penalty.
-8 months
The Medicare Beneficiary will receive (upon admittance to a Medicare approved hospital) a document called, __________.
-“An Important Message from Medicare”
J a fifty-five (55) year old has been receiving Social Security disability for the past _____ months and is now eligible for Medicare.
-24 months
The Special Enrollment Period provides a (n) _____ period to enroll in Medicare without penalty.
-8 month
Medicare Part A claims and payments are “handled” by what organization?
-Medicare Administrative Contractors (MAC)
Medicare coverage starts the following ______ following the General Enrollment Period (GEP).
-July 1st
Medicare is generally the primary coverage in most situations but when is Medicare the secondary?
- Workers’ Compensation
- No-Fault or Liability Insurance
- Black Lung Benefits
S worked two (2) years past her age sixty-five (65) for an employer that had fifty (50) employees enrolled in the group health plan. She now wants to enroll in Medicare and is concerned about paying a penalty. What provision in Medicare will allow her to enroll without a penalty?
-Special Enrollment Period (SEP)
What is the length of time that the Initial Enrollment Period (IEP) lasts?
-7 months
Medicare Beneficiaries will receive what document that indicates the method used in settling a Part B claim?
-Medicare Summary Notice
If an enrollee was born on the first day of the month, the Medicare benefits begin when?
-first day of the previous month
Congress established the original Medicare program in what year?
-1965
The Prospective Payment System under Medicare Part A uses what payment categories to determine payment for covered claims?
-Diagnosis Related Groups
Group health care plans that have at least ____ enrollees will require the group plan to be the primary payer.
-20
Medicare may pay a claim on a ___________ and recover the payments later from the responsible party.
-Conditional Basis
