Lecture 11 and 12 done Flashcards
What is medicare?
government isurance that is federally funded by title XVIII of the social security act
Who is eligle for medicare?
us citizens 65+, or under 65 with permanant disability, end stage renal disease, or amyotrophic lateral sclerosis
How many different parts are there for medicare?
4
What is covered by medicare part A?
hospital insurance that is a mandatory benefit. Include inpatient, nursing facility, home healthcare, hospice and ED
How is medicare part A structured?
day 0-60: one time deductable
day 60-90: daily copay
day 90+: no coverage
What is covered under medicare part B?
optional benerfit that covers preventative sevices and has limited drug coverage, fee for service payment
Describe medicare part B cost sharing?
annual deductible, coinsurance 20%, balance billing for out of network
what is not covered by medicare A or B?
long term care, physical exams, vision/hearing, dental, homemaker services, outpatient drugs, pharmacist clinical services
do pharmacist have provider status within medicare?
no, but there is a proposed bill to assist in medically underserved areas
What would federal pharmacist provider status provide?
allosw pharmacist to serve underserved area under Part B, bill for 85% of a physician fee
What is covered under medicare part C?
optional benefot that offers managed care plans, has a HMO/PPo structure, prepaid care, replaces part A and B
What is covered under medicare part D?
outpatient perscription drug coverage, optional benefit, premium penalty if no crediable coverage
What is the Part D coverage gap?
known as the donut hole, caused when can’t afford drugs so you stop taking/skip doses
Describe Part D structure?
standard benefit v. actuual beneft which must be as generous as standard benefit, many different plans, can negotiate drug prices
What is a pharmacist role in Part D?
plan selection, immunozations and vaccines, Medication therapy management,
