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IL Life and Health Insurance > Medicare and Medicaid > Flashcards

Medicare and Medicaid Flashcards

1
Q

MCR: Eligibility

A

65 and over; Anyone with SS disability insurance for 2 years; End-stage renal disease

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2
Q

MCR: Available regardless of…

A

Financial need

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3
Q

MCR Part A

A

Pays upon being admitted to a hospital or nursing home and for hospice care

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4
Q

MCR A: Requires deductibles and copays but…

A

No premium for people who’ve paid taxes for approx. 10 years

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5
Q

MCR A: No coverage for…

A

Non-admitted emergency room visits, hospital stays for observation, phone/tv services

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6
Q

MCR A: Benefit Period

A

Will reset deductibles and co-payments

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7
Q

MCR A: Benefit period starts when…

A

Admitted to hospital or SNF

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8
Q

MCR A: Benefit period ends…

A

60 days after discharge

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9
Q

MCR A: Benefit period is…

A

Per admission/discharge, not per year

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10
Q

MCR A: Each benefit period pays for…

A

100% of first 60 days of hospitalization after deductible

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11
Q

MCR A: What days require co-payment?

A

61-90

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12
Q

MCR A: Each person has how many lifetime reserve days?

A

60

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13
Q

MCR A: Only covers skilled care, not…

A

Custodial Care

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14
Q

MCR A: SNF stay must be preceded by…

A

3-day hospital stay

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15
Q

MCR A: First 20 days are covered at…

A

100%

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16
Q

MCR A: Days 21-100 require…

A

Daily copayment

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17
Q

MCR A: No coverage after…

A

100 days

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18
Q

MCR A: SNF stay must be with…

A

MCR approved provider

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19
Q

MCR Part B

A

Covers outpatient treatment, emergency room visits, doctor visits and prescribed medical equipment

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20
Q

MCR B: Also includes…

A

Blood transfusions while not hospitalized

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21
Q

MCR B: Requires…

A

Monthly premium, annual deductible, and per-service coinsurance fees

22
Q

MCR B: Generally pays for…

A

80% of reasonable charges

23
Q

MCR B: Optional but…

A

Has 10% premium increase every 12 months of late enrollment

24
Q

MCR Exclusions

A

Cosmetic surgery, hearing aids, glasses, dentures and most dental care, custodial care

25
Q

MCR Part C

A

Medicare advantage plans administered by private insurers

26
Q

MCR C: Covers…

A

Same services as MCR plus maybe more (glasses, hearing aids, etc)

27
Q

MCR C: Might have different…

A

Deductible and copay requirements

28
Q

MCR C: Typically offered as managed care via…

A

Special network of providers

29
Q

MCR Part D

A

Optional prescription drug coverage

30
Q

MCR D: Each plan covers it’s own…

A

Formulary of coverage

31
Q

MCR D: Premiums can’t differ based on age or health but can…

A

Cost more for people with high income or who delay enrollment

32
Q

MCR D: What premium penalty for each month of late enrollment based on federal bas premium?

A

1%

33
Q

MCR Supplements/Medigap

A

Help pay copays and coinsurance fees in Pts A and B

34
Q

Medigap plans are intended for…

A

Traditional MCR, not MCR Advantage

35
Q

Medigap plans are standardized by…

A

Federal government and are known by plan letter

36
Q

Medigap plans can’t deny someone or charge more for health reasons if…

A

Enrolling within six months of initial MCR eligibility

37
Q

Medigap plans can still exclude…

A

Pre-existing conditions, 6 month exclusion within previous 6 months

38
Q

Medigap plans cannot exclude pre-existing conditions if…

A

Applicant had creditable coverag within 62 days of applying

39
Q

Group health insurance with less than 20 people is usually…

A

Secondary for worker’s 65 or older

40
Q

Plans with 20 or more people can’t offer less coverage to working seniors and…

A

Can still be primary for people 65 or older

41
Q

Medicaid

A

Federal and state partnership for people with few or no income/assets

42
Q

MCD: Most common way of paying for…

A

LTC services

43
Q

MCD rules differ by…

A

State

44
Q

MCD: Either no monthly income above a few thousand dollars or…

A

Monthly income above a few thousand dollars must be spent down on medical care

45
Q

MCD asset limits differ by…

A

State

46
Q

MCD: Seniors must have no more than…

A

Few thousand dollars of assets, other than primary residence, automobile, and personal items

47
Q

MCD: Penalties for transferring assets within…

A

5 year look back period prior to applying

48
Q

Some states limit MCD to seniors plus…

A

Families with children

49
Q

Some states have expanded MCD to include…

A

Adults under 65 who make less than 133% of the poverty level, regardless of assets, and don’t have access to insurance at work

50
Q

MCD: Seniors must still satisfy income and…

A

Asset requirements

IL Life and Health Insurance (29 decks)

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