Health Finance Flashcards
What does Part A of Medicare consist of?
- Covers hospital costs
- No premium costs
- SNF care: max 100 days
- Some home health care, hospice care
What does Part B (Medigap) of Medicare consist of?
- Premium costs deducted from SS
- Covers physician costs: not required
- Medical supplies
- Drugs admin in MD offices
What does Part C (Medicare Advantage) of Medicare consist of?
- Parts A + B + D (may cover broader list of services)
- Managed care (private insurance companies)
What does Part D of Medicare consist of?
- Drug benefit
- Premium costs deducted from SS
When does enrollment in Medicare Part A start?
Enrollment can begin about 3 months before 65th birthday
When are you not allowed to enroll into Medicare Part A?
You do not have to enroll as long as you have a comparable insurance plan
Do you have to be retired to be eligible for Medicare Part A?
No, you do not have to be retired
What is not covered by Part B?
- Long term care, dental care, cosmetic surgery, eye examinations for prescribing glasses, routine foot care
- Hearing aids and exams, acupuncture
General rules for meds of part A, B, D: Where is each used?
- A: used in the hospital
- B: doctor’s office
- D: used at home
General rules for meds of part A, B, D: what is it for?
If drug is given at hospital, it would be part A, but if drug is taken at home, it would be part D
What is Medigap?
- 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
What is Medicare Part C?
- Managed care
- Also called Medicare Advantage plans
What are the features of advantage plans?
- Admin by private companies
- Premiums or service costs can be lower than original Medicare
- May offer extra benefits like vision and dental
What is the Medicare STAR rating system?
Used by CMS to measure how well Medicare advantage and part D plans perform
What is Medicare part D?
- Largest change in insurance processing in retail pharmacy history
- Run by private insurance companies, but CMS sets minimum standards
Which part of the Medicare plan was never funded originally?
Part D
When did Medicaid begin?
Began Jan 1, 1966
What is Medicaid for?
Health insurance for the poor and medically indigent of all ages
Is Medicaid a requirement for states?
No, AZ was the last state to implement in 1982
How is Medicaid managed?
Through federal state partnership program:
- matching funds based on state per capita income
- federal standards for services
- managed by state govt
What are important Medicaid milestones in 2014?
- 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
Who are the majority eligible subgroups in IN’s expanded Medicare?
Children and pregnant women
Who qualifies for Medicaid?
- 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
How long are pregnant mothers covered by Medicaid after pregnancy ends?
12 months
