Medicare and Medicaid Flashcards
Medicare pays a large portion of the health care bill for persons who:
-are age 65 or over
-have end-stage renal disease
-have been receiving Social Security disability benefits for at least 24 months
Qualification for Medicare requires:
-individual to be “fully insured” according to social security
-accumulating at least 40 credits by generating a minimum amount of work-related income over at least the past 10 years and paying social security (FICA) taxes
Private healthcare insurance companies process medical claims for Medicare and are known as:
Medicare Administrative Contractors (MAC)
The initial enrollment for Medicare is a _____-month prior that begins _____ months before the month an individual turns 65, includes the month they turn 65, and ends ___ months after the month they turn 65
Seven; three; three
Medicare part A covers:
Hospital, skilled nursing facility, hospice, and home health care
Medicare part B covers:
Medical care provided by physicians and other medical servicesp
Medicare part C covers:
Health care delivered by managed care plans
Medicare part D covers:
Prescription drugs
For people age 65 and covered by Social Security, enrollment in Medicare Part A is _______ on the first day of the month that they reach age 65 and is _____
Automatic; free
Medicare Part A hospital coverage is based on _______ _______ rather than the calendar year
Benefit periods
A Medicare part A inpatient hospital benefit period begins when:
Someone is admitted to the hospital and ends 60 days after discharge
For each Medicare part A inpatient hospital benefit period, coverage and cost-sharing amounts are as follows:
-the patient pays a deductible, which changes annually
-days 1-60: fully paid by Medicare (after the deductible)
-days 61-90: Medicare pays most of the cost, and the patient pays a daily co-pay amount which changes each year
_______ care and _______ care are NOT covered by Medicare
Intermediate; custodial
Medicare covers skilled nursing facility care if:
-it is a Medicare-approved facility
-the SNF stay begins immediately after release from a hospital stay of at least 3 days
Medicare coverage and cost-sharing amounts for a skilled nursing facility are:
-day 1-20: fully paid by Medicare
-days 21-100: Medicare pays most of the cost and the patient pays a daily co-pay amount which changes each year
-after day 100, Medicare pays nothing
If a patient is confined at home, Medicare Part A’s home health care benefit covers:
-visits by a home health aide to provide medical services such as part-time nursing care and physical, occupational, or speech therapy
-80% of the cost of durable medical equipment such as hospital beds or wheelchairs
Medicare part A exclusions:
-first 3 pints of blood
-private duty nursing
-non-medical services
-intermediate care
-custodial care
Individuals who enroll in Medicare Part A are ______ enrolled in Part B unless they request otherwise
Automatically
Medicare Part B is ______ and required a monthly ________
Optional; premium
The Medicare Part B premium is tied to;
An individual’s income level and is deducted from the social security monthly benefit check
If an individual initially declines Medicare Part B enrollment, they can enroll during the general enrollment period that occurs each year from ______ _ through _____ __ and coverage starts at the beginning of the following month
January 1; March 31
Medicare Part B provides coverage for 3 general kinds of medical services:
Inpatient and outpatient physician services, home health care if not covered by Part A, and outpatient medical services and supplies
Some preventative care is included under Medicare Part B:
-an initial routine physical exam within the first 6 months of enrollment
-screening tests for cholesterol, diabetes, and colorectal cancer
-annual mammograms (age 40+), Pap tests, pelvic exams, and clinic breast exams for women
-annual prostate cancer screenings for men age 50+
-glaucoma testing one ever 12 months
-Bone mass measurements for qualified individuals
-flu shots
Medicare part B has an annual deductible that changes each year and also a __% coinsurance
20
