Medicare

Question 1

Noncovered Inpatient-Hospital Expenses (5)

Answer 1

Non-medically necessary services or supplies
Private-duty nurse or other private-duty attendant
Deluxe or non-medically necessary private room
Personal convenience items
Non-physician inpatient services that have not been provided directly or arranged for by hospital staff

Question 2

Additionally Covered Expenses When They Meet Certain Criteria (5)

Answer 2

Inpatient rehabilitation
Skilled nursing
Some personal convenience items for long-term illness/disability
Home health visit
Hospice care

Question 3

Drugs, Biologicals, Supplies, Appliances, and Equipment (3)

Answer 3

FDA-approved drugs and biologicals for use in the hospital
When unreasonable or impossible to limit the use to the inpatient period
Hospital must have purchased item

Question 4

When does the patient pay the difference between private and semiprivate room? (2)

Answer 4

Private room is not medically necessary
Patient has requested the private room

Question 5

When does the patient NOT pay the difference between private and semiprivate room?

Answer 5

When isolation is required to avoid jeopardizing the health or recovery of the patient or others

Question 6

Part B Provides Coverage for Non-Hospital Charges (6)

Answer 6

Physician services
Outpatient hospital services
Home health care
Medically necessary supplies and equipment
Those services and supplies not covered under Part A that are medically necessary
Payment for the hospital stay if the patient has exhausted all Part A benefits prior to admission

Question 7

Part C: Medicare Advantage Plans (5)

Answer 7

Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Private Fee-for-Service (PFFS)
Special Needs Plans (SNPs)
HMO Point of Service (HMOPOS)

Question 8

Part D: Prescription Drug, Improvement, and Modernization Act of 2003 (3)

Answer 8

Prescription drug plan
Premium paid by beneficiary
Reimbursements based on the diagnoses of patients within the plan