Medicare and Medicaid Flashcards
MCR: Eligibility
65 and over; Anyone with SS disability insurance for 2 years; End-stage renal disease
MCR: Available regardless of…
Financial need
MCR Part A
Pays upon being admitted to a hospital or nursing home and for hospice care
MCR A: Requires deductibles and copays but…
No premium for people who’ve paid taxes for approx. 10 years
MCR A: No coverage for…
Non-admitted emergency room visits, hospital stays for observation, phone/tv services
MCR A: Benefit Period
Will reset deductibles and co-payments
MCR A: Benefit period starts when…
Admitted to hospital or SNF
MCR A: Benefit period ends…
60 days after discharge
MCR A: Benefit period is…
Per admission/discharge, not per year
MCR A: Each benefit period pays for…
100% of first 60 days of hospitalization after deductible
MCR A: What days require co-payment?
61-90
MCR A: Each person has how many lifetime reserve days?
60
MCR A: Only covers skilled care, not…
Custodial Care
MCR A: SNF stay must be preceded by…
3-day hospital stay
MCR A: First 20 days are covered at…
100%
MCR A: Days 21-100 require…
Daily copayment
MCR A: No coverage after…
100 days
MCR A: SNF stay must be with…
MCR approved provider
MCR Part B
Covers outpatient treatment, emergency room visits, doctor visits and prescribed medical equipment
MCR B: Also includes…
Blood transfusions while not hospitalized
MCR B: Requires…
Monthly premium, annual deductible, and per-service coinsurance fees
MCR B: Generally pays for…
80% of reasonable charges
MCR B: Optional but…
Has 10% premium increase every 12 months of late enrollment
MCR Exclusions
Cosmetic surgery, hearing aids, glasses, dentures and most dental care, custodial care
MCR Part C
Medicare advantage plans administered by private insurers
MCR C: Covers…
Same services as MCR plus maybe more (glasses, hearing aids, etc)
MCR C: Might have different…
Deductible and copay requirements
MCR C: Typically offered as managed care via…
Special network of providers
MCR Part D
Optional prescription drug coverage
MCR D: Each plan covers it’s own…
Formulary of coverage
MCR D: Premiums can’t differ based on age or health but can…
Cost more for people with high income or who delay enrollment
MCR D: What premium penalty for each month of late enrollment based on federal bas premium?
1%
MCR Supplements/Medigap
Help pay copays and coinsurance fees in Pts A and B
Medigap plans are intended for…
Traditional MCR, not MCR Advantage
Medigap plans are standardized by…
Federal government and are known by plan letter
Medigap plans can’t deny someone or charge more for health reasons if…
Enrolling within six months of initial MCR eligibility
Medigap plans can still exclude…
Pre-existing conditions, 6 month exclusion within previous 6 months
Medigap plans cannot exclude pre-existing conditions if…
Applicant had creditable coverag within 62 days of applying
Group health insurance with less than 20 people is usually…
Secondary for worker’s 65 or older
Plans with 20 or more people can’t offer less coverage to working seniors and…
Can still be primary for people 65 or older
Medicaid
Federal and state partnership for people with few or no income/assets
MCD: Most common way of paying for…
LTC services
MCD rules differ by…
State
MCD: Either no monthly income above a few thousand dollars or…
Monthly income above a few thousand dollars must be spent down on medical care
MCD asset limits differ by…
State
MCD: Seniors must have no more than…
Few thousand dollars of assets, other than primary residence, automobile, and personal items
MCD: Penalties for transferring assets within…
5 year look back period prior to applying
Some states limit MCD to seniors plus…
Families with children
Some states have expanded MCD to include…
Adults under 65 who make less than 133% of the poverty level, regardless of assets, and don’t have access to insurance at work
MCD: Seniors must still satisfy income and…
Asset requirements
