Medicare And Medicaid

Question 1

Eligibility for Medicare coverage

Answer 1

65 or over
Kidney failure (end-stage renal disease)
Received social security disability for at least 24 months

Question 2

4 parts of Medicare coverage

Answer 2

Part A (hospital, skilled nursing, hospice, home health care)

Part B (covers medical care provided by physicians and other medical services)

Part C (covers health care delivered by managed care plans)

Part D (Covers prescription drugs)

Question 3

Medicare part A enrollment

Answer 3

Automatic for persons turning 65 and eligible for social security

Supported by payroll taxes

Premium charge for those not fully qualified for social security

Question 4

Part A hospital coverage

Answer 4

90 days per benefit period
New benefit period starts 60 days after discharge
Additional 60 lifetime reserve days
Deductible benefit period-after deductible Medicare pays 100% of first 60 days
Patient copays for days 61-90
Patient pays a higher daily copay for lifetime reserve days

Question 5

Skilled nursing facility

Answer 5

Medical treatment 
Following a hospital stay of at least 3 days
100days of coverage
- day 1-21 100% paid by Medicare
- day 21-100 daily co pay by patient

Question 6

Home health care

Answer 6

Skilled care provided in home
Not sitting services
100% paid by Medicare
Medicare pays 80% of durable medical equipment in the home

Question 7

Hospice

Answer 7

Comfort for terminally ill and family

Can be provided in the home or an approved facility

Question 8

Part A exclusions

Answer 8

First 3 pints of blood
Private duty nursing
Non-medical services
Intermediate care
Custodial care

Question 9

Medicare part B enrollment

Answer 9

Monthly premium that increases with income level
Not required (can have part a only)
Initial enrollment period (3 months before 65, month of age 65, 3 months after 65)
Annual open enrollment
- Jan 1 through March 31 each year, coverage effective July 1

Question 10

Preventative care from Medicare part B

Answer 10

An initial routine physical examination within the first 6 months of enrollment

Screening tests
Annual mammograms 
Annual prostate cancer screening
Glaucoma testing 1nce a year
Bone mass measurements
Flu shots

Question 11

Coverage and cost sharing

Answer 11

Coverage
- Doctor
- Outpatient services
- Home Health
Calendar year deductible 
80/20 coinsurance after deductible 
No stop loss

Question 12

Part B exclusions

Answer 12

Routine foot, vision, dental, or hearing care
Most immunizations
Most outpatient prescription drugs
Physician charges above Medicare’s approved amount
Private duty nursing
Cosmetic surgery
Most care received outside of US
Expenses incurred as a result of war