Medicare Flashcards
Who is covered under Medicare and how does reimbursement work
- Individuals 65+ (eligible for social security)
- People with End stage renal disease
- People with ALS
- People permanently disables after receiving benefits the last two years
What does Dual Eligible Mean?
Low income beneficiaries who also qualify for Medicaid
- Qualify for full Medicaid benefits including Long Term Care and dental
- Helps with premiums, deductibles, and subsidies that pay for coverage
What is Medigap?
Policies sold by private insurance
- Supplemental insurance for people with Medicare - to cover some things traditional Medicare does not (you must have part A and B to qualify)
- You pay premium (in addition to part B premium)
What is the coverage gap called under the Part D program?
Donut hole
- Enrollee pays 25% coinsurance and plan pays 75% for drug costs between 4660 and 7400
Is Home modification covered under Medicare
NO - No waivers either
What does the repeal of OT cap for Medicare B mean
Allows people to continue getting care above 2150 limit that was in place
- Before there were no exceptions once the threshold was hit
- Got rid of KX modifiers for services that exceeded threshold
Driving Rehab Coverage for Medicare
In clinic eval covered
- Does not cover on road assessment or adaptive equipment
DME coverage under Medicare
Doctor prescription and medical necessity needed
- Canes/walker
- Commodes
- Hospital beds
- Some wheelchair and power mobility
Medicare Part A
- In patient hospital stays (semi-private rooms, meals, general nursing, drugs)
- Skilled nursing facilities (semi-private room, meals, Skilled nursing, PT/OT, counseling, meds, supplies, ambulances
- Hospice Care (MD, nursing, medical equipment, drugs, aide, PT/OT/Speech, counseling, Pain management)
- Post Acute Care Home Health (Intermittent nursing/PT/OT/Speech)
Medicare Part B
- Out-patient services (hospital care, physician and preventive services)
- Ambulances, Labs, DME, Kidney supplies, diagnostics, out-patient mental health
Medicare Part C
All of A and B and sometimes D
- Extra benefits like (eyeglasses, hearing exam, dental, podiatry, gym, chiropractic services)
Medicare Part D
Drug plans
