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Population Health > Medicare > Flashcards

Medicare Flashcards

1
Q

Who qualifies for Medicare?

A

-Pts 65+
=Pts with certain disabilities
Everyone with ESRD, amyotrophic lateral sclerosis (ALS)

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2
Q

What changed on the Medicare card?

A

SSN is no longer used as ID

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3
Q

How many people does Medicare cover?

A

52 million Americans

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4
Q

When was Medicare enacted?

A

1965

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5
Q

When was drug benefit added?

A

1988–but repealed in 1989 and added again in 2000/passed in 2002/implemented in 2006

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6
Q

Part A covers what?

A

Hospital

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7
Q

Part B covers what?

A

Medical equipment, outpatient services, preventative services, ambulance

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8
Q

Part C is what?

A

Combined A & B - Medicare Advantage Plan

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9
Q

Part D is what?

A

Drugs (those that aren’t included in Part A/B)

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10
Q

Who has to pay for Part A coverage?

A

People who haven’t worked for 10 full years

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11
Q

How doe Medicare pay hospitals?

A

Based on average cost to treat the condition

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12
Q

What’s the Hospital stay deductible?

A

$1340

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13
Q

When do patients have to start paying for hospital (what day)?

A

After day 60–$335 per day

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14
Q

When does a benefit period end?

A

60 days without service in a row (so if readmitted within 60 days, same benefit period)

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15
Q

How many days do you have to spend in hospital before SNF?

A

3 days

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16
Q

How long can you stay in SNF before costs aren’t covered at all?

A

100 days

$0 for first 20 days

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17
Q

Are prescription drugs in SNF covered?

A

Nope (part D)

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18
Q

Do you have to have a prior hospitalization to qualify for home health coverage?

A

Nope

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19
Q

Is 24-hour home nursing care covered?

A

Nope

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20
Q

Is hospice care covered?

A

Yep - but no treatments to cure

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21
Q

When is home health aid/homemaker services covered?

A

With hospice care

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22
Q

When does Part A cover outpatient Rx drugs?

A

Hospice care

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23
Q

T/F: Part B is required`\

A

False! You can opt out

24
Q

Is Part B free?

A

Nah - pay based on income

25
Q

How much does Part B cover?

A

80% after deductible

26
Q

Is LTC covered by Medicare Part B?

A

No

27
Q

Is chiropractor covered by Medicare part B?

A

Yep

28
Q

Is visual covered by Medicare Part B?

A

Optometrist is–but not eye exams to cover glasses

29
Q

Is dental covered by Medicare Part B?

A

No

30
Q

Is podiatrist covered by Medicare Part B/

A

Yep

31
Q

Which drugs are covered by Part B?

A 
Injectables in doctor's office
Drugs administered through Part-B covered DME (nebulizer or insulin pump and BG testing supplies)
EPO for ESRD
Oral anti-cancer
Oral anti-emetics w/cancer
Oral immunosuppressive w/transplant
PEN and enteral nutrition
32
Q

If a med is used in the hospital, which Medicare covers it?

A

A

33
Q

If a med is used in the doctor’s office, which Medicare covers it?

A

B

34
Q

If a med is used at home, which Medicare covers it?

A

D

35
Q

What is Medigap?

A

A medicare supplement to cover deductibles for Part A and B, and other preventative care (can cover some without covering at all–different plans)

36
Q

What is eligibility for Part C?

A

Have Medicare A & B
Live in service area
Do not have ESRD

37
Q

What is covered in Part C sometimes that’s not in A/B?

A

Prescriptions
Vision
Dental
hearing

38
Q

What is an HMO?

A

Can only go to doctors, specialists or hospitals on the plan’s list

39
Q

What is PPO?

A

Pay less if you use in-network providers

Out of network costs more

40
Q

What is PFFS?

A

May go to any Medicare doctor that accepts plan’s payment - will have contracted physicians
Insurance plan decides how much it will pay and what you pay

41
Q

What’s the advantage of Medicare Advantage?

A
  • Premiums/copays might be lower
  • May offer extra benefits
  • May have prescription benefits
  • Coordinate care
  • Easy billing
  • No Medigap needed
42
Q

What’s the late enrollment penalty?

A

1% per month of every patient who was eligible but no enrolled & didn’t have credible drug coverage

43
Q

Part D has a monthly premium?

A

True

44
Q

Part D has annual deductible?

A

True (sometimes)

45
Q

Part D has coinsurance?

A

True

46
Q

Part D has coverage limit?

A

True (then donut hole)

47
Q

When does patient reach donut hole?

A

$3750

48
Q

When does catastrophic coverage start?

A

$7509

49
Q

How much TrOOP do patients have to pay before deductible met?

A

$5000

50
Q

What percent of cost do beneficiaries pay now in the donut hole?

A

35% of brand

44% of generic

51
Q

What is the Low-Income Benefit?

A

Extra assistance based on FPLs

52
Q

What does the CMS online tool do?

A

Provide lists of formularies/plans available to patients based on their drug list and preferred pharmacy

53
Q

How can you enroll in a PDP?

A

-call them
mail in form
-online (PDP’s website)

54
Q

T/F: Pharmacies can distribute PDP marketing materials and enrollment forms

A

True

55
Q

T/F: Pharmacies can distribute MA or MA-PDP marketing materials and enrollment forms

A

False! No enrollment forms

56
Q

T/F: A pharmacy can collect enrollment applications

A

False

57
Q

T/F: Pharmacies can provide health screenings while distributing PDP enrollment information

A

False! Health screenings are prohibited marketing activities

Population Health (1 decks)

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