Medicare And Medicaid Flashcards

1
Q

Eligibility for Medicare coverage

A

65 or over
Kidney failure (end-stage renal disease)
Received social security disability for at least 24 months

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2
Q

4 parts of Medicare coverage

A

Part A (hospital, skilled nursing, hospice, home health care)

Part B (covers medical care provided by physicians and other medical services)

Part C (covers health care delivered by managed care plans)

Part D (Covers prescription drugs)

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3
Q

Medicare part A enrollment

A

Automatic for persons turning 65 and eligible for social security

Supported by payroll taxes

Premium charge for those not fully qualified for social security

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4
Q

Part A hospital coverage

A

90 days per benefit period
New benefit period starts 60 days after discharge
Additional 60 lifetime reserve days
Deductible benefit period-after deductible Medicare pays 100% of first 60 days
Patient copays for days 61-90
Patient pays a higher daily copay for lifetime reserve days

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5
Q

Skilled nursing facility

A
Medical treatment 
Following a hospital stay of at least 3 days
100days of coverage
- day 1-21 100% paid by Medicare
- day 21-100 daily co pay by patient
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6
Q

Home health care

A

Skilled care provided in home
Not sitting services
100% paid by Medicare
Medicare pays 80% of durable medical equipment in the home

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7
Q

Hospice

A

Comfort for terminally ill and family

Can be provided in the home or an approved facility

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8
Q

Part A exclusions

A
First 3 pints of blood
Private duty nursing
Non-medical services
Intermediate care
Custodial care
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9
Q

Medicare part B enrollment

A

Monthly premium that increases with income level
Not required (can have part a only)
Initial enrollment period (3 months before 65, month of age 65, 3 months after 65)
Annual open enrollment
- Jan 1 through March 31 each year, coverage effective July 1

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10
Q

Preventative care from Medicare part B

A

An initial routine physical examination within the first 6 months of enrollment

Screening tests
Annual mammograms 
Annual prostate cancer screening
Glaucoma testing 1nce a year
Bone mass measurements
Flu shots
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11
Q

Coverage and cost sharing

A
Coverage
- Doctor
- Outpatient services
- Home Health
Calendar year deductible 
80/20 coinsurance after deductible 
No stop loss
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12
Q

Part B exclusions

A
Routine foot, vision, dental, or hearing care
Most immunizations
Most outpatient prescription drugs
Physician charges above Medicare’s approved amount
Private duty nursing
Cosmetic surgery
Most care received outside of US
Expenses incurred as a result of war
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