Health Coverage for Seniors

Question 1

Medigap

Answer 1

Plans that supplement Medicare plans by covering the gaps. These plans pay the deductible and coinsurance amounts from Medicare, as well as pay for service not covered under regular Medicare.

Question 2

Medicare Cost Plan

Answer 2

Similar to Medicare HMOs, but if a non-network provider is used, original Medicare covers the care. They can also be joined or left at any time.

Question 3

Indemnity vs. Actual Cost of Care Policies

Answer 3

The two ways benefits are paid for long term care policies. Indemnity policies pay a fixed amount per day. Actual cost of care policies pay for the actual cost of care up to a specific limit.

Question 4

Medicare Advantage

Answer 4

Medicare Managed Care Plans or Medicare Part C. Available to Medicare recipients. In order to join, they must be enrolled in Medicare Parts A and B; and they cannot have ESRD.

Question 5

Medicare Part A Cost Share

Answer 5

Medicare Part A covers skilled nursing for 100 days in a facility. The first 20 days are no cost share and days 21-100 require a copay.

Question 6

Medigap Plan M

Answer 6

Has same benefits as Part A, and covers 50% of Part A deductible, and coverage for skilled nursing coinsurance amount.

Question 7

Medicare Eligibility

Answer 7

Anyone 65 or over, people under 65 with certain disabilities, and anyone with ESRD.

Question 8

Inpatient Coverage Under Medicare

Answer 8

Medicare pays for semiprivate room, meals, general nursing, and supplies. No coverage for private room unless authorized, private duty nursing, and IP mental health is limited to 150 days per lifetime. Medicare does not cover custodial care; only home care (non-medical) when needed. Skilled nursing only covered after three day IP stay.

Question 9

Premiums for Regular Medicare

Answer 9

Medicare A has no premium. Medicare Part B has premium, deductible and 20% coinsurance.

Question 10

Chronically ill

Answer 10

Someone who is not terminally ill, but meets the criteria of either 1. cannot perform at least 2 ADLs 2. requires substantial supervision

Question 11

Enrollment Period for Medicare

Answer 11

3 months prior to turning 65, month you turn 65, and 3 months after you turn 65. If they do not enroll during this time, they can enroll between 1/1 - 3/31 each year. For Part D, you can enroll between 10/15 - 12/7.