1.5 Medicare and Medicaid Flashcards

1
Q
Medicare has 4 parts:
Part A \_\_\_\_\_\_\_\_\_\_ insurance
Part B \_\_\_\_\_\_\_\_\_\_ insurance
Part C \_\_\_\_\_\_\_\_\_\_ insurance
Part D \_\_\_\_\_\_\_\_\_\_ insurance
A

Hospital, Medical, Medicare Advantage Plan, Prescription Drugs

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2
Q
Medicare part A pays for:
1. 
2.
3.
4.
A
  1. Inpatient hospital stays (acute, critical access, inpt rehab, LTC)
  2. skilled nursing facility stays
  3. some home health care
  4. hospice care
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3
Q

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

A

90, benefit

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4
Q

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.

A

60

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5
Q

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

A

100

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6
Q

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

A

is

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7
Q
Medicare Part B pays for:
1. 
2.
3.
4. 
5.
6.
7.
A
  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
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8
Q

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

A

B

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9
Q

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

A

Medicaid, states, Federal.

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10
Q

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

A

long-term, personal care

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11
Q

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

A

3

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12
Q
Medicaid eligibility varies from state to state, but in general covers limited income individuals in the following categories:
1. 
2. 
3. 
4. 
5. 
6.
A
  1. people 65 or older
  2. children under 19
  3. Pregnant women
  4. Disabled individuals
  5. parent caring for a child
  6. eligible immigrant
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13
Q

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

A

states, Federal

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14
Q

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

A

mandatory benefits, optional benefits

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15
Q

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.

A

spousal impoverishment

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16
Q

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.

17
Q

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

A

Transfers of assets for less than fair market value

18
Q

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.

19
Q

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

20
Q

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.

21
Q

______ month waiting period for benefits to begin for SSDI.

22
Q

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

A

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

23
Q

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

A

24, Medicare, 29

24
Q

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

A
  1. children
  2. widow/widower
  3. Adults who havent worked but have been disabled since childhood
25
is a needs based program that makes cash assistance payments to disabled individuals with limited income and resources
Supplemental Security Income (SSI)
26
Individuals eligible for SSI are also eligible for?
Medicaid
27
SSI Benefit types: 1. 2. 3.
1. age 2. disability (any age; including children) 3. Blindness (any age)
28
Is the healthcare program for service members (active, guard/reserve, and retired) and their families.
Tricare
29
Tricare options: 1. 2. 3.
1. Tricare Prime: HMO type 2. Tricare Extra: PPO type 3. Tricare Standard: Fee-for-service
30
Eligibility for most VA benefits is based on?
1. discharge from active military service under other than dishonorable conditions.
31
Many veterans qualify for cost-free healthcare based on ____________ conditions or other qualifying factors.
service- connected