Assignment 11 - Overview of Medicare Flashcards
Medicare services are provided through two trust funds.
- _____ provides coverage for Part A services
- the ____ trust fund provides services for ambulatory services and Part D services.
- The hospital insurance (HI) trust fund
- supplementary medical insurance (SMI)
Typically, people become eligible for Medicare Part A in the same way as they become eligible for Social Security:
They work for ten years in jobs covered by the program.
- With Social Security, individuals may choose to receive benefits as early as age _____, and eligibility for full benefits depends on year of birth.
- Under Social Security, those born in ___ or earlier can receive full benefits at age 65.
- However, those born after 1959 do not receive full benefits until age ___.
- 62
- 1937
- 67
Medicare Part A covers (4)
- inpatient hospital care
- skilled nursing home care
- home health visits
- a handful of other largely inpatient benefits such as inpatient psychiatric care and hospice care.
begins when the person is hospitalized and ends when the person has been out of a hospital or skilled nursing facility for 60 days.
a spell of illness
The various copays are all tied by law to the size of the hospital deductible.
The hospital copay is ____ of the deductible, the lifetime reserve copay is ___of the deductible, and the skilled nursing facility copay is ____ of that same deductible.
25%
50%
12.5%
Medicare Part A covers up to ___ home health visits. These visits must require part-time or intermittent skilled nursing care or physical or speech therapy to homebound persons. There is no deductible or copay associated with these services, but they must follow ________.
100
a minimum three- day hospital stay
Describe the eligibility requirement for Medicare Part B and explain why virtually everyone purchases this coverage (2)
- can purchase even if you dont purchase part A
- heavily subsidized
Medicare Part B covers: (9)
An annual deductible applies as well as a 20% coinsurance rate on reasonable fees.
- physician services
- durable medical equipment
- outpatient hospital services
- outpatient mental health services
- clinical laboratory and diagnostic tests
- outpatient occupational
- physical and speech therapy
- some home health care
- some preventive screening services.
Are Medicare Part B premiums higher for high-income beneficiaries?
Yes
Under Medicare Advantage, enrollees can choose from five different types of health plan arrangements. These are:
- (1) A health maintenance organization (HMO) that typically has a closed panel of providers but may have a point-of-service option
- (2) A preferred provider organization (PPO) that typically allows enrollees to use nonplan providers for an extra copay
- (3) A private fee-for-service (PFFS) plan, in which enrollees can typically go to any physician or hospital that agrees to accept the plan’s payment terms
- (4) A Medicare medical savings account (MSA), similar to a health savings account (HSA), in which the beneficiary has a high deductible and an HMO, PPO or PFFS, together with an account into which Medicare deposits money
- (5) A special needs plan (SNP), designed for those who may live in a nursing home, are dually eligible for Medicaid, or who have specific chronic or disabling conditions
Anyone eligible for ___ coverage is also eligible for Medicare Part D, a voluntary program.
Part B
after the enrollee has spent a certain amount of money for covered drugs, he or she may have to pay more for drugs up to a certain limit.
This coverage gap is known as the donut hole.
The level of the deductible and the thresholds for the various phases of the coverage that define the donut hole are adjusted each year to reflect inflation; in 2014 the brand-name discount was ___and the generic drug discount was ___.
47.5%
28%
The OASI, DI and HI trust funds are all funded from___
The only reason for increases
payroll taxes
inflation
