1.5 Medicare and Medicaid

Question 1

Medicare has 4 parts:
Part A \_\_\_\_\_\_\_\_\_\_ insurance
Part B \_\_\_\_\_\_\_\_\_\_ insurance
Part C \_\_\_\_\_\_\_\_\_\_ insurance
Part D \_\_\_\_\_\_\_\_\_\_ insurance

Answer 1

Hospital, Medical, Medicare Advantage Plan, Prescription Drugs

Question 2

Medicare part A pays for:
1. 
2.
3.
4.

Answer 2

1. Inpatient hospital stays (acute, critical access, inpt rehab, LTC)
2. skilled nursing facility stays
3. some home health care
4. hospice care

Question 3

Medicare covers up to ___ days of medically necessary inpatient hospital care per _______ period.

Answer 3

90, benefit

Question 4

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.

Answer 4

60

Question 5

Home health under Medicare part A covers the first ___ visits following 3-day hospitalization or SNF stay.

Answer 5

100

Question 6

Medicare part B is voluntary insurance; this ___ a monthly premium for coverage

Answer 6

is

Question 7

Medicare Part B pays for:
1. 
2.
3.
4. 
5.
6.
7.

Answer 7

1. Physician/surgeon services
2. outpatient services
3. Some home health
4. Durable medical equipment
5. Emergency room care
6. Preventative Services
7. Ambulance services

Question 8

Medicare Part __ covers home health care not associated with a hospital or SNF stay

Answer 8

B

Question 9

_____ is a health insurance program funded jointly by the ______ and the ______ government for individuals with limited income and resources.

Answer 9

Medicaid, states, Federal.

Question 10

Medicaid also covers services not normally covered by Medicare, such as ______ support and services, as well as ______________ services.

Answer 10

long-term, personal care

Question 11

Coverage can be retroactive up to ___ months prior to the month of application if the individual would have been eligible during the retroactive period.

Answer 11

3

Question 12

Medicaid eligibility varies from state to state, but in general covers limited income individuals in the following categories:
1. 
2. 
3. 
4. 
5. 
6.

Answer 12

1. people 65 or older
2. children under 19
3. Pregnant women
4. Disabled individuals
5. parent caring for a child
6. eligible immigrant

Question 13

_____ establish and administer their Medicaid programs. They also determine the type, amount, duration, and scope of services, within the _____ guidelines.

Answer 13

states, Federal

Question 14

States are required to cover certain “_____________” and can choose to provide “____________”

Answer 14

mandatory benefits, optional benefits

Question 15

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.

Answer 15

spousal impoverishment

Question 16

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.

Answer 16

30

Question 17

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

Answer 17

Transfers of assets for less than fair market value

Question 18

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.

Answer 18

SSDI

Question 19

The disability must be expected to last for at least ______ or to result in death

Answer 19

1 year

Question 20

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.

Answer 20

SSDI

Question 21

______ month waiting period for benefits to begin for SSDI.

Answer 21

5

Question 22

Approval for SSDI can come quickly if the individual has one of the ____ ____ ____ named on the ____ ____ ___________; otherwise obtaining ____ approval is a ____ processs.

Answer 22

serious medical conditions, social security compassionate allowances list, SSDI, Long

Question 23

after receiving SSDI for __ months an individual is eligible for _______ including the 5-month waiting period, this equals ___ months before medicare eligibility

Answer 23

24, Medicare, 29

Question 24

SSDI can be paid to:
1.
2.
3.

Answer 24

1. children
2. widow/widower
3. Adults who havent worked but have been disabled since childhood

Question 25

is a needs based program that makes cash assistance payments to disabled individuals with limited income and resources

Answer 25

Supplemental Security Income (SSI)

Question 26

Individuals eligible for SSI are also eligible for?

Answer 26

Medicaid

Question 27

SSI Benefit types:
1.
2.
3.

Answer 27

1. age
2. disability (any age; including children)
3. Blindness (any age)

Question 28

Is the healthcare program for service members (active, guard/reserve, and retired) and their families.

Answer 28

Tricare

Question 29

Tricare options:
1.
2.
3.

Answer 29

1. Tricare Prime: HMO type
2. Tricare Extra: PPO type
3. Tricare Standard: Fee-for-service

Question 30

Eligibility for most VA benefits is based on?

Answer 30

1. discharge from active military service under other than dishonorable conditions.

Question 31

Many veterans qualify for cost-free healthcare based on ____________ conditions or other qualifying factors.

Answer 31

service- connected