Medicare Part C & D Flashcards
What do you have to be enrolled in order to be eligible for Part C?
Medicare Parts A & B
Who provides services under Part C?
Approved HMO or PPO
What is a Private Fee-for-Service Plan?
Medicare pays a private insurance company who decides how much the insured pays.
What is the Special Needs Plan under Part C?
Specialized care for those who have Medicare AND Medicaid
Reside in a nursing home
OR have certain chronic medical conditions
What must you be enrolled in to be eligible for Part D?
Part A
or Parts A & B
What did the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 do for Part D?
Add prescription drug benefits to standard coverage
Who is automatically enrolled in Part D?
Medicaid recipients
If you don’t enroll when you’re first eligible for Part D, what is the penalty?
1% for each delayed month
What do you have to pay under Part D?
Monthly premium and deductible
After the deductible for Plan D is met, how much of the cost is covered?
75% until a limit is reached
What happens when the limit is reached in Plan D and what is this called?
Donut hole
Must pay 100% of costs
If spending during the gap in Part D reaches the limit coverage what goes into effect?
Catastrophic coverage
How much does Catastrophic Coverage pay?
95% of prescription drug costs
If you are covered under a group plan AND Medicare which is the primary policy?
The group insurance
Who sells Medigap?
Private insurers and HMOs
