Unit 34: Social Health Insurance out of order! Flashcards
Page 493
When does Medicare’s hospital inpatient care benefit period begin and end?
Benefit period begins upon admission and ends 60 days after discharge
Is REadmission during this 60 day period considered PART of the same benefit period?
Yes
What happens if a patient is readmitted AFTER the 60 days run out?
It is considered the beginning of a new benefit period.
Page 492
Can you sign up for Medicare Part B outside of the initial enrollment period?
Yes
What is a general enrollment period for Medicare and when does coverage begin?
January 1 – March 31
The following July 1
What 4 kinds of care does Medicare Part A cover?
- inpatient hospital
- skilled nursing facility
- home health care
- hospice care
(person wrote on page “exclusively copay” whatever that means)
Page 491
What two parts make up Medicare benefits ?
Part A – hospital insurance
Part B – Supplementary medical insurance
Who is eligible for Part A?
automatically for those who are entitled to Social Security
When are they eligible for Part A Hospital insurance?
the first day of the month in which they turn 65
(BTY, I’m getting it Oct. 1)
Who is eligible for Part B?
enrollment is voluntary and requires monthly premiums
When can Part B kick in?
when person becomes eligible for Part A, they enroll in a Part B plan (with a premium) unless they sign form saying not wanting Part B.
(i.e. My part B is Blue Chip for Medicare - through Blue Cross)
What happens if someone enrolls in Part B before the month they reach age 65?
Coverage still begins on the first day of month turning 65 just like Part A
What if someone enrolls in Part B later?
coverage begins later (duh)
Page 495
What is covered under Medicare Part B Supplementary Medical Insurance?
- doctors services
- home health care (if not covered by Part A)
- Outpatient medical services and supplies
Does Medicare Part B require an annual deductible and copay?
Yes
What services in Part B require an annual deductible/copay?
ALL Part B covered services
How is Part B’s deductible/copay different from Part A’s?
In Part A, each benefit provided has its OWN UNIQUE copay for the patient
Under Part B, what 3 items are always the responsibility of the patient?
- annual deductible
- 20% of “reasonable” charges for covered, medically necessary service
- first 3 pints of blood
Page 496
What is an “assignment” that a doctor/supplier can agree to regarding Medicare patients?
They agree to accept Medicare’s approved amounts as full payment and cannot legally bill the patient.
(If they don’t accept the assignment, patient must pay diff between Medicare value for a service and what doc/supplier charges
What is specifically excluded from Part B coverage?
Only one highlighted in list of 7 on this page is:
- Hearing exams, fitting for hearing aids
(NOT covered)
Page 494 (page number is blurry - image 00121)
What is the respite care benefit under Hospice care with Medicare
temporary care in a hospice facility for patient normally cared for at home. (Respite is usually to give caregivers a break)
How long does respite care last?
No more than 5 consecutive days
Page 503
What is Medicare SELECT?
It is a version of Medicap policy (policies that fill in the cap that Part A does not cover).
Only diff is that SELECT is operated on a preferred provider basis.
Page 505
What are Health Savings Accounts - HSA’s
Tax-free bank accts that hold money earmarked for health care
