Chapter 17: Private Insurance Plans for Seniors Flashcards
Medicare Supplements
Health insurance that provides coverage to fill the gaps in Medicare coverage
Medicare Select
A type of Medicare supplement (medigap) plan sold in some states that can be any medigap plans (A-N) but requires policy holders to receive services within network
Medicare Part D
A program that offers a prescription drug benefit to help pay for drugs they need.
Available for those entitled to Medicare Part A and Part B.
Custodial Care
Must be administered under a physician’s order
Medical care given to meet daily personal needs such as dressing, bathing, getting out of bed.
Home Health Care
Part Time skilled or unskilled cared provided in-home
Adult Day Care
Offered in care centers; a custodial type of care designed for those who require assistance with activities of daily living
Respite Care
A type of health or medical care designed to provide a short rest period for a caregiver.
Temporary.
Core Benefits
All Medicare supplement plans cover coinsurance on hospital costs, up to an additional 365 days after Medicare Part A hospital benefits run out
Long-Term Care Partnership Programs
A federally-supported, state-operated initiative that allows those who purchase a qualified long term care insurance policy to protect a portion of their assets
Continuing Care
Designed to provide a benefit for elderly individuals who live in a continuing care retirement community
Medicare, persons under age 65
Anyone who has received SSDI benefits or railroad benefits for at least 24 months (following 5 month waiting period) because they cannot work before reaching age 65-
Exceptions to the waiting rule:
1. Persons with Amyotrophic lateral sclerosis
2. Persons with end-stage renal disease
Original Medicare
Administered by the federal government and includes;
Medicare Part A
Medicare Part B
Original Medicare Cost-Sharing mechanisms
- Deductible
- Coinsurance
-daily for some hospital services
-20% of medicare approved cost for physician services
Medicare Part D
Seperate drug plan
Medigap
A policy to help pay remaining helaath care costs, copay, coinsurance and deductibles
Medicare Advantage
An all-in-one alternative to the Original Medicare; includes Part A and Part B.
Medicare Part A
1) Monthly premiums are non-existent if worker has 40 quarters (10 years of employment) paid in
2) If not fully insured, based on 0-39 credits ($259) and 0-29 credits ($471).
3) Penalty for not enrolling: Monthly premium of 10% for 2x number of years they delayed.
Part B
-Optional; monthly premium IF elected ($148.50)
- $88K + $176K pay higher premiums
- Penalty: 10% premium penalty per each 12-month period.
2 Conditions when someone 65+ can delay Medicare Part B:
- Covered through a group health insurance plan at work
- Worker’s employer is a qualified COBRA group (20 employees or more)
Medicare Part A
*AKA Hospital Insurance; inpatient hospital care, skilled nursing care, home health care and hospice care
*Federal payroll and self-employment taxes
*Assigns a new benefit period per claim instead of per year
Excludes Physician and Surgeon Charges
Benefit Period of Medicare Part A
Date of one’s admission and ends 60 days after one is discharged from care.
Medicare Part A; Basic Inpatient Benefits
*90 days of inpatient hospital care
*Extra 60 Lifetime Reserve Days (not renewable)
