1.5 Medicare and Medicaid Flashcards
Medicare has 4 parts: Part A \_\_\_\_\_\_\_\_\_\_ insurance Part B \_\_\_\_\_\_\_\_\_\_ insurance Part C \_\_\_\_\_\_\_\_\_\_ insurance Part D \_\_\_\_\_\_\_\_\_\_ insurance
Hospital, Medical, Medicare Advantage Plan, Prescription Drugs
Medicare part A pays for: 1. 2. 3. 4.
- Inpatient hospital stays (acute, critical access, inpt rehab, LTC)
- skilled nursing facility stays
- some home health care
- hospice care
Medicare covers up to ___ days of medically necessary inpatient hospital care per _______ period.
90, benefit
A benefit period begins when the beneficiary is first admitted to the hospital. It ends when the patient has been out of the hospital or skilled nursing facility for at least ___ consecutive days.
60
Home health under Medicare part A covers the first ___ visits following 3-day hospitalization or SNF stay.
100
Medicare part B is voluntary insurance; this ___ a monthly premium for coverage
is
Medicare Part B pays for: 1. 2. 3. 4. 5. 6. 7.
- Physician/surgeon services
- outpatient services
- Some home health
- Durable medical equipment
- Emergency room care
- Preventative Services
- Ambulance services
Medicare Part __ covers home health care not associated with a hospital or SNF stay
B
_____ is a health insurance program funded jointly by the ______ and the ______ government for individuals with limited income and resources.
Medicaid, states, Federal.
Medicaid also covers services not normally covered by Medicare, such as ______ support and services, as well as ______________ services.
long-term, personal care
Coverage can be retroactive up to ___ months prior to the month of application if the individual would have been eligible during the retroactive period.
3
Medicaid eligibility varies from state to state, but in general covers limited income individuals in the following categories: 1. 2. 3. 4. 5. 6.
- people 65 or older
- children under 19
- Pregnant women
- Disabled individuals
- parent caring for a child
- eligible immigrant
_____ establish and administer their Medicaid programs. They also determine the type, amount, duration, and scope of services, within the _____ guidelines.
states, Federal
States are required to cover certain “_____________” and can choose to provide “____________”
mandatory benefits, optional benefits
In 1988 Congress enacted provisions to prevent what has come to be called “____________” - that is, when the spouse still living at home has little to no income or resources.
spousal impoverishment
Under the Medicaid spousal impoverishment provisions, a certain amount of the couple’s combined resources is protected when one spouse enters a nursing facility or other medical institution and is expected to remain there for at least _____ days.
30
This practice is prohibited for the purpose of establishing Medicaid eligibility. It applies when assets are transferred, sold, or gifted for less than they are worth by individuals in long-term care facilities
Transfers of assets for less than fair market value
To be eligible for _____ , an individual must be unable to perform the work they previously did and not be able to adjust to other work because of the condition.
SSDI
The disability must be expected to last for at least ______ or to result in death
1 year
is based on work record, funded by social security taxes, for those over 18 and under 65, covers blind or disabled workers. Focuses on physical and mental impairments.
SSDI
______ month waiting period for benefits to begin for SSDI.
5
Approval for SSDI can come quickly if the individual has one of the ____ ____ ____ named on the ____ ____ ___________; otherwise obtaining ____ approval is a ____ processs.
serious medical conditions, social security compassionate allowances list, SSDI, Long
after receiving SSDI for __ months an individual is eligible for _______ including the 5-month waiting period, this equals ___ months before medicare eligibility
24, Medicare, 29
SSDI can be paid to:
1.
2.
3.
- children
- widow/widower
- Adults who havent worked but have been disabled since childhood
