Medicare/Medicaid

Question 1

Medicare made up of:

Answer 1

Part A (Inpatient)
Part B (Outpatient)
Part C (Medicare Advantage)
Part D (Prescription Drug Benefit)
Medicaid

Question 2

What is Medicare’s share of the federal budget?

Answer 2

15%

Question 3

What is covered in Medicare part A:

Answer 3

Home health care
Hospice care
Inpatient care in hospitals
Inpatient care in critical access hospitals
SNF

Question 4

How many days are covered under Medicare part A in a SNF?

Answer 4

100 days

Question 5

Who is covered under Medicare?

Answer 5

People age 65 or older
Some people under age 65 with disabilities
People with End-Stage Renal Disease (ESRD)

Question 6

When does a benefit period begin?

Answer 6

begins the day you’re admitted as an inpatient in a hospital or SNF

Question 7

When does a benefit period end?

Answer 7

when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row.”

Question 8

Premium for part A:

Answer 8

$0 for most people worked more than 40 quarters

Premiums if worked less than 40 quarters

Question 9

What is the deductible for each benefit period?

Answer 9

$1316

Question 10

Days 1-60 hospital:

Answer 10

$0 coinsurance

Question 11

Dags 61-90 hospital:

Answer 11

$329 coinsurance per day

Question 12

Days 91-150 hospital:

Answer 12

lifetime reserve days
$658 per day
Up to 60 days over patient’s lifetime

Question 13

Beyond lifetime reserve days hospital:

Answer 13

all costs borne by patient

Question 14

Amount of SNF deductible?

Answer 14

no deductible

Question 15

Days 1-20 SNF:

Answer 15

$0 coinsurance

Question 16

Days 21-100 SNF:

Answer 16

$164.50 coinsurance per day

Question 17

Days 100+ SNF:

Answer 17

All costs borne by patient

Question 18

Home Health cost per benefit period:

Answer 18

No deductible

20% of the Medicare approved amount for durable medical equipment

Question 19

Hospice cost per benefit period:

Answer 19

$0 for hospice care

Question 20

Cost outpatient rehab:

Answer 20

20% coinsurance based on the Medicare Physician Fee Schedule (MPFS)

Question 21

What is Medicare Part A funded by?

Answer 21

a federal payroll 2.9% tax paid by both employees and employers
1.45% paid by employer and employee

Question 22

Social Security tax rate:

Answer 22

12. 4%

6. 2% by employer and employee

Question 23

When do you no longer pay the social security tax?

Answer 23

When your gross pay exceeds $118,500 (in 2017)

Question 24

PPS

Answer 24

Prospective Payment System

Medicare sets the price

Question 25

IRF requirements:

Answer 25

Patients must receive 3 hours of PT-OT-SLP (or any combination thereof) per day at least 5 days per week

Question 26

SNF requirement:

Answer 26

3 day Part A stay in an acute hospital bed

Skilled level of care still required (nursing, rehab)

Question 27

What is covered under Medicare part B?

Answer 27

Physician services
Outpatient hospital care
Home health (if patient is not homebound)
Covered supplies if medically necessary

Question 28

Cost of Medicare part B?

Answer 28

Annual deductible of only $183.00 in 2017

$109.00 monthly premium in 2017

Question 29

What is means tested?

Answer 29

Is tied to annual income

Question 30

What is Medicare part B funded by?

Answer 30

Enrollee premiums

Allocations from general taxation

Question 31

Primary therapy caps:

Answer 31

$1,980 for PT + SLP
$1,980 for OT
change every year

Question 32

Secondary therapy caps:

Answer 32

$3,700 for PT + SLP
$3,700 for OT
remains the same every year

Question 33

Features of Medicare part C:

Answer 33

Medicare Advantage
Allows seniors to opt out of traditional Medicare & into HMOs or PPOs that have contracted with CMS
Medicare pays premiums to insurers

Question 34

How do you qualify for Medicare Advantage?

Answer 34

Must have both Medicare A & B to qualify

Question 35

Medicare Appeal Levels:

Answer 35

Level 1: Heath Plan
Level 2: Independent Organization
Level 3: OMHA
Level 4: Medicare Appeals Council
Level 5: Federal Court

Question 36

Medicare Donut hole:

Answer 36

75% covered up to $3,701
Beneficiary responsible for $3,701 - $7,425
Is the “donut hole”
95% coverage after $7,425

Question 37

Medicaid enrollment and benefits:

Answer 37

variable from state to state

Question 38

Categorically needy:

Answer 38

Low income families with children
Individuals receiving SSI
Pregnant women, infants, and children with incomes less than a specified percent of the Federal poverty level
Qualified Medicare beneficiaries

Question 39

SSI:

Answer 39

Supplemental Security Income: A Federally-funded needs-based disability program for adults and children which provides monthly cash benefits and, in most states, automatic Medicaid eligibility)

Question 40

ACA Medicare expansion:

Answer 40

The uniform income requirement is a minimum of 133% of the federal poverty level for EVERYONE