Medicare Flashcards
What is the age requirement for Medicare and what is the penalty for not enrolling when 65
If you apply before: you will start having coverage on the first day of your birth month
If you apply after: you will start coverage on the 1st of the next month after your birthday
Penalty: your premium could possibly rise 10% and you will have to pay twice as much from when you would have starter Part A
Who are the individuals covered by Medicare?
- 65+
- those with disabilities
- US citizens and legal residents that have been living in the U.S for 5 consecutive years
How much does someone pay for Medicare and how long someone has to pay into Medicare?
- 1.45%
- 4 quarters
Part _ is mostly funded by the ____ ____.
- Part A
- payroll tax
What does the 3 pronged administrative system consist of?
- CMS
- Social Security Administration
- Claims Administration
What is CMS?
operates Medicare, oversees general financing, maintains and reviews utilization records
What is the claims administration?
contracts with CMS and determines reasonable charges for covered services and guarde against unnecessary utilization
What is an example of a claims administrator?
Blue Cross Blue Shield
What is the Department of Health and Human Services?
Social Security Administration reviews Medicare eligibility and enrollment
What does Medicare Part A?
covers hospital care (general and psychiatric);
What is covered under Medicare Part A
SNF care, home health, and hospice
What is Medicare Part B?
care provided by a physician (or applicable provider) in an inpatient or outpatient setting
What is Medicare Part C?
Covers both hospital and Medicare services provided in all types of settings
What is Medicare Part D?
Prescription Drug Benefit; covers treatment costs for patients
