Governement Financing: Medicare, Medigap, And Medicare Advantage

Question 1

What are parts A, B, C, D of Medicare

Answer 1

A: hospital
B: medical
C: alternative
D: prescription

Question 2

What are the options of government financing health care

Answer 2

1. Medicare
2. Medicaid
3. CHIP

Question 3

What is social security disability

Answer 3

1. Provides assistance to people with disabilities
2. Pays benefits to patient and certain members of family is insured
   *insured = worked long enough (10 years) and paid social security taxes

Question 4

What are the qualification for social security

Answer 4

1. Not working for at least 12 months
2. Condition significantly limits ability to do basic works
3. Disability is likely to last for more than one year or result in death

Question 5

How is Medicare financed?

Answer 5

1. Hospital insurance trust fund
2. Supplementary medical insurance (SMI) trust fund

Question 6

What is the hospital insurance trust fund

Answer 6

How its it funded ?
1. Payroll taxes paid by most employees, employers and people who are self employed
*income taxes paid on social security benefits
*interest earned on trust fund investments
*medicare part A premiums from people who aren’t eligible for premium free part A

Question 7

What is supplementary medical insurance trust fund

Answer 7

How is it funded?
1. Funds authorized by congress
2. Premium from people enrolled in Medicare part B and D
*other sources like interest earned on the trust fund investments

Question 8

How to be eligible for Medicare

Answer 8

1. People 65 or older
2. Under 65 and totally and permanently disabled (24 months)
3. People of any age with chronic renal disease requiring dialysis or transplant
4. Must sign up, it is not automatic
   *will receive welcome to Medicare packet 3 months before 65

Question 9

When does coverage start for Medicare

Answer 9

1. The first day of the month you turn 65
   *within the first 12 months you can obtain a one time only preventive visit at no cost

Question 10

What does original Medicare include

Answer 10

1. Part A and part B
   *hospital and medical

Question 11

What are the components of Medicare part A (Hospital)

Answer 11

1. Automatically enrolled once turn 65 if you paid into social security for at least 10 years
2. Usually no monthly premium

Question 12

What are the components of Medicare part B (Medical)

Answer 12

1. Must pay a premium every month even if you dont use it
   *standard premium in 2023 is $164
2. Pay $226 per year for part B deductible
3. After the deductible is met typically pay 20% of Medicare approved amount for doctor visits

Question 13

What are the two types of services that Medicare part B (Medical) cover

Answer 13

Medically necessary services
1. Services or supplies that are needed to diagnose or treat medical conditions
Preventive services
1. Used to prevent illness or detect at early stage when treatment will work best

Question 14

What services are not covered in Medicare

Answer 14

1. Long term care
2. Most dental care
3. Eye exams
4. Cosmetic surgery
5. Acupuncture
6. Hearing aids

Question 15

What are the components of Medicare part D (prescription plan)

Answer 15

1. Optional benefit and often only partial, not full medication coverage
2. If you want a drug coverage, can join Medicare part D
   *open enrollment periods
3. Monthly premium, on top of part B premium

Question 16

What is the maximum deductible for prescription plan (Medicare part D)

Answer 16

1. $505
   *each plan has own list of covered dugs

Question 17

What are tier 1,2,3 of Medicare part D

Answer 17

1. Lowest copayment, most generic prescription drugs
2. Medium copayment, preferred, brand name prescription drugs
3. Higher copayment, non-preferred brand name prescription drugs
   Specialty tier: highest copayment, very high cost prescription drug

Question 18

What is the coverage gap (part D)

Answer 18

Donut hole
1. Temporary limit on what drug plan will cover for drugs
2. Not everyone enters the coverage gap
3. Once you have spent $4,660 you have enter the coverage gap

Question 19

What is medi gap

Answer 19

Supplement insurance
1. Helps with copayment, coinsurance, and deductibles
2. Medicare pay its share (80%) then gap policy pays it share
3. Added to retired individuals
4. Does not add benefits like vision, dental, hearing aid
5. Does not cover cost for prescription drugs

Question 20

When does medi gap start

Answer 20

1. The month of your 65th birthday
   *still need to pay private insurance company a monthly premium for medi gap policy

Question 21

What is Medicare part C (Medicare advantage)

Answer 21

“All in one” alternative to original Medicare
1. Private companies contract with Medicare to provide coverage
*bundles include part A, B and usually D
2. Often offers extra benefits
*may have lower out of pocket costs
3. Monthly premium paid by Medicare

Question 22

What are the most common Medicare advantage plans

Answer 22

1. Health maintenance organization
2. Preferred Provider organization
3. Private fee for service
4. special needs plans

Question 23

What are the qualifications needed to joint Medicare advantage plus

Answer 23

1. Living in the plans service area
2. Having Medicare parts A and B