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PHRM 849 > Health Finance > Flashcards

Health Finance Flashcards

1
Q

What does Part A of Medicare consist of?

A
  • Covers hospital costs
  • No premium costs
  • SNF care: max 100 days
  • Some home health care, hospice care
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2
Q

What does Part B (Medigap) of Medicare consist of?

A
  • Premium costs deducted from SS
  • Covers physician costs: not required
  • Medical supplies
  • Drugs admin in MD offices
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3
Q

What does Part C (Medicare Advantage) of Medicare consist of?

A
  • Parts A + B + D (may cover broader list of services)
  • Managed care (private insurance companies)
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4
Q

What does Part D of Medicare consist of?

A
  • Drug benefit
  • Premium costs deducted from SS
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5
Q

When does enrollment in Medicare Part A start?

A

Enrollment can begin about 3 months before 65th birthday

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6
Q

When are you not allowed to enroll into Medicare Part A?

A

You do not have to enroll as long as you have a comparable insurance plan

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7
Q

Do you have to be retired to be eligible for Medicare Part A?

A

No, you do not have to be retired

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8
Q

What is not covered by Part B?

A
  • Long term care, dental care, cosmetic surgery, eye examinations for prescribing glasses, routine foot care
  • Hearing aids and exams, acupuncture
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9
Q

General rules for meds of part A, B, D: Where is each used?

A
  • A: used in the hospital
  • B: doctor’s office
  • D: used at home
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10
Q

General rules for meds of part A, B, D: what is it for?

A

If drug is given at hospital, it would be part A, but if drug is taken at home, it would be part D

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11
Q

What is Medigap?

A
  • Not admin through CMS, but standardized by federal law
  • Picks up deductibles for Part A
  • Picks up deductibles and copays for part B
  • Purchased through private companies
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12
Q

What is Medicare Part C?

A
  • Managed care
  • Also called Medicare Advantage plans
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13
Q

What are the features of advantage plans?

A
  • Admin by private companies
  • Premiums or service costs can be lower than original Medicare
  • May offer extra benefits like vision and dental
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14
Q

What is the Medicare STAR rating system?

A

Used by CMS to measure how well Medicare advantage and part D plans perform

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15
Q

What is Medicare part D?

A
  • Largest change in insurance processing in retail pharmacy history
  • Run by private insurance companies, but CMS sets minimum standards
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16
Q

Which part of the Medicare plan was never funded originally?

A

Part D

17
Q

When did Medicaid begin?

A

Began Jan 1, 1966

18
Q

What is Medicaid for?

A

Health insurance for the poor and medically indigent of all ages

19
Q

Is Medicaid a requirement for states?

A

No, AZ was the last state to implement in 1982

20
Q

How is Medicaid managed?

A

Through federal state partnership program:
- matching funds based on state per capita income
- federal standards for services
- managed by state govt

21
Q

What are important Medicaid milestones in 2014?

A
  • ACA goes into affect expanding Medicaid eligibility for states that chose to opt in
  • Allows ppl w income up to 138% of FPL to qualify
22
Q

Who are the majority eligible subgroups in IN’s expanded Medicare?

A

Children and pregnant women

23
Q

Who qualifies for Medicaid?

A
  • Low income families (<138% of FPL in IN)
  • Infants born to Medicaid eligible pregnant women
  • Children <6yo and pregnant women w incomes <158% in IN
24
Q

How long are pregnant mothers covered by Medicaid after pregnancy ends?

A

12 months

25
Q

What are the mandatory services of Medicaid?

A

LTC, hospital, physician, home health, prenatal care, family planning services

26
Q

What are the optional services of Medicaid?

A

Pharmacy, dental, ICF for mentally retarded, mental health rehab

27
Q

What are the enrollment %s of Medicaid

A
  • about 85 million covered by Medicaid + CHIP
  • Assist 60% of all nursing home residents
  • Assist 40% of all childbirths
28
Q

What is a problem with dental coverage in Medicaid?

A

While children are eligible for dental coverage, few dentists participate

29
Q

What are the Rx provisions in the American Rescue Plan?

A
  • Requires the federal govt to negotiate prices for some drugs
  • Require drug companies to pay rebates for Medicare
  • Cap out of pocket spending

PHRM 849 (4 decks)

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