Medicare and Medicaid Flashcards
What does the FICA tax consist of?
Social Security, tax 6.2%, is applied to wages for the employer share and and 6.2% employee pays with a base cap of 168,600. Self-employed individuals pay a rate of 12.4% on net income.
Medicare tax has no ceiling for earnings and is 1.45% for both the employee and the employer self-employed taxpayers pay 2.9% on net income.
Total self employment, taxes equal 15.3% when you combine the both.
An additional Medicare tax of .9% applies to individual wages paid in excess of $200,000 regardless of filing status.
What are the four parts to Medicare benefits?
Part A covers, hospital care, skilled nursing care, hospice care at home health care
Part B is optional and covers physician fees, and outpatient services
Part C Medicare advantage, plans, health plan, options that are part of the Medicare program allows individuals to choose alternatives to parts, a and B must pay part B premium
Medicare part D prescription drug coverage everyone is eligible
Who is eligible for Medicare benefits?
Almost everyone age 65 and older is eligible for part A
Any age with in stage renal disease eligible for Medicare part A
Person he was age 65 receiving monthly Social Security, or railroad retirement, benefits, part A
People who have been receiving Social Security disability benefits for at least 24 months are also eligible for Medicare benefits
Individuals who are eligible for Medicare, but still working, must be given an option to participate in their employers group insurance. Medicare coverage would be secondary to any health insurance employer plan would be primary.
What is the cost of Medicare part A premium?
Most do not pay if they have 40 or more quarters of Medicare covered employment
$278 in 2020 for people with 30 to 39 quarters of Medicare covered employment
$505 for all others
What is the premium for Medicare part B?
$174.70 for 2024, but may be higher for individuals with annual gross income is greater than $103,000
People who are eligible for part A coverage are automatically enrolled in part B coverage if part B is not wanted persons may opt out
What are the benefits that Medicare part a offer?
Hospital care benefits
Skilled nursing care benefits
home health care benefits
Hospice benefits
What are Medicare part A hospital care benefits?
Pays for hospital services up to 90 days and each benefit period. Benefit period ends when the patient is out of the hospital for 60 consecutive days. New benefit begins.
Lifetime reserve 60 additional days is available
Each benefit period hospital expenses are paid in full for 60 days subject to a deductible of $1632 in 2024 for days 61, 290 patient pays coinsurance of $408 per day. Patient coinsurance for the lifetime reserve is $816 per day .
Book two page 87
What is the amount of skilled nursing home care coverage under Medicare part A?
Pay full benefits for first 20 days of skilled nursing care
Days, 21 to 100: patient coinsurance is $204 per day 2024
Does not provide coverage after 100 days
Does Medicare part a provide custodial or long-term care coverage?
No, it is not
What are the home health care benefits under Medicare part a?
Pays for the first 100 home health visits
Medical equipment is covered. Individual responsible for a 20% coinsurance.
What are the Medicare part a hospice benefits?
Life expectancy must be six months or less
Limited to 210 days, unless the individual is recertified as terminally ill
What are Medicare part B benefits?
$240 deductible for 2024 then all covered services are paid at 80% insured responsible for the remaining 20%
Covered expenses include physician services, home health services, not requiring a hospital stay diagnostic test, medical equipment, all outpatient services of a hospital
What is Medicare part C Medicare advantage plans?
Health plan, options that are part of the Medicare program allows individuals to choose alternatives to parts, a and B must pay part B premium
What plan types are offered under Medicare part C
HMOs, PPOs, private fee for service plans, Medicare special-needs plans
Who is eligible for Medicare part D prescription drug coverage
Everyone is eligible
Are individuals required to pay monthly premium and a yearly deductible under Medicare part D
Yes, can vary based on plan chosen
What services are not covered by Medicare part a
Services of physicians (covered under part B) services of surgeons (covered under part B), private rooms, television, or other luxuries cosmetic surgery custodial care
What services are not covered by Medicare part B
Routine, immunizations, cosmetic surgery, dental care, eyeglasses in hearing aids, orthopedic shoes, and routine foot care
Note cosmetic surgery is covered if caused by an accident
What is Medigap?
Supplemental policies that are signified by letters, a is the most basic and inexpensive each of which has a different set of basic and extra benefits
And what is Medicaid?
Federal and state medical insurance program for needy people
What assets generally count towards Medicaid eligibility
Checking and savings accounts
Stocks and bonds
Certificates of deposits
Real property, other than a primary residence
Additional motor vehicles
What Medicaid assets generally do not count toward eligibility?
Primary residence
Personal property and household belongings
One motor vehicle
Life insurance with a face value under $1500
Up to $1500 and fun set aside for burial
Assets held in specific trust. However, if a transfer is made within a 60 month, look back. Applicant is in eligible for Medicaid benefits for a length of time equal to the amount transferred divided by the monthly cost of nursing home care for the region.
