Medicare And Medicaid Flashcards
Eligibility for Medicare coverage
65 or over
Kidney failure (end-stage renal disease)
Received social security disability for at least 24 months
4 parts of Medicare coverage
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)
Medicare part A enrollment
Automatic for persons turning 65 and eligible for social security
Supported by payroll taxes
Premium charge for those not fully qualified for social security
Part A hospital coverage
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
Skilled nursing facility
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
Home health care
Skilled care provided in home
Not sitting services
100% paid by Medicare
Medicare pays 80% of durable medical equipment in the home
Hospice
Comfort for terminally ill and family
Can be provided in the home or an approved facility
Part A exclusions
First 3 pints of blood Private duty nursing Non-medical services Intermediate care Custodial care
Medicare part B enrollment
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
Preventative care from Medicare part B
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
Coverage and cost sharing
Coverage - Doctor - Outpatient services - Home Health Calendar year deductible 80/20 coinsurance after deductible No stop loss
Part B exclusions
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