Social Insurance Flashcards
federal medical expense insurance program for people 65 and older even if they continue to work
medicare
4 parts of medicare
hospital insurance (payroll tax) , medical insurance (financed through monthly premiums) , medicare advantage (receive health services through providers) , prescription drug (for medicines)
helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care
Part A
when an individual first becomes eligible for medicare
initial enrollment period
between Jan 1st and March 31st
general enrollment period
any time during the year if the individual or their spouse is still employed and covered under a group health plan
special enrollment period
must cover all services covered under the Original Medicare except hospice care and some care in qualifying clinical research studies
medicare advantage
provides more focused and specialized health care for specific groups of people
special needs plan
offer coverage on a fee-for-service basis
standalone plans
group coverages together
integrated plans
when the beneficiary is responsible for a portion of prescription drug costs
donut hole
when the beneficiary hits their spending limit during the donut hole
catastrophic coverage
policies issued by private insurance companies that are designed to fill in some of the gaps in Medicare
Medigap
the purpose of this law was to eliminate questionable marketing practices and to provide customers with a degree of protection and to standardize the protection afforded.
OBRA
How long is an open enrollment period for Medicare supplement policies?
6 months
how long is the medigap free look period?
30 days
federal and state funded program for those whose income and resources are insufficient to meet the cost of necessary medical care
medicaid
how long is the waiting period to receive benefits for social security?
5 months. they start on the 6th
based on the persons average indexed earnings on which social security taxes have been paid
Primary insurance amount (PIA)
what is an eligibility requirement for social security disability income benefits
fully insured status
A insured is covered under a medicare policy that provides a list of network health care providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. What type of Medicare policy does the insured own?
MEDICARE select
Which of the following is NOT a factor determining qualifications for Social Security disability benefits?
Workers occupation
What is not covered by part A of medicare?
physicians and surgeons services
In order for an insured under Medicare part A to receive benefits for care in a skilled nursing facility, which of the following conditions would have to be met?
the insured must have been hospitalized for 3 days
if a person is disabled at age 27 and meets social securities definition of total disability, how many work credits must he or she have earned to receive benefits?
12 credits
who is medicaid funded by?
federal and state
Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days?
20
