Medicare Flashcards
Medicare
is an federal insurance program for people 65 and older, as well as those who are covered by social security disability insurance and clients with end stage renal failure
Medicare Part A
No monthly premiums
Hospitalizations
Post-Acute Rehabilitation
Home Care
Hospice
Medicare Part B
Covers medically necessary services including professional fees for provider visits and outpatient services, outpatient physical therapy, mental health therapies, and durable medical equipment.
Requires monthly premium and 20% co-insurance after the deductible is met.
Medicare Part B - Welcome to Medicare and Annual Wellness
Cancer Screening: Cervical, Colorectal, Mammogram, Prostate
Immunizations: Flu, Hepatitis, Pneumococcal
Other Diagnostics: Bone Density, Cardiovascular Disease Screening,
Diabetes Screening
Sexually Transmitted Infections screening
Mental Health: Substance abuse screening, depression screening, tobacco cessation, cognitive screening
Medicare Part C
also known as Medicare Advantage. The federal government pays a monthly premium to a private company such as a PPO or HMO, and the person receives benefits, including prescription programs, through the company.
Medicaid
is a health insurance option for people who do not have sufficient income to pay for services. Joint funded by federal and state governments.
Medicaid Eligibility
Requires being at or higher than 133% of the federal poverty level.
- Which of the following statement about community-based services is true?
a. Senior centers may be used only by low-income older adults.
b. Funding for Meals on Wheels is solely from local sources.
c. Area Agencies on Aging usually do not provide services directly to older adults.
d. The majority of the Administration on Aging budget goes to nutrition programs and community-based supportive services.
d. The majority of the Administration on Aging budget goes to nutrition programs and community-based supportive services.
- Which sentence completion is false? The Veterans Health Administration:
a. Is an integrated network of service providers across the United States
b. Serves a population with an average age of nearly 65 years
c. Provides care management only for individuals with disabilities that are service related
d. Can provide older adults home-based primary care, geriatric assessment, and long- term care
c. Provides care management only for individuals with disabilities that are service related
- When a Medicare beneficiary with only traditional Part A and Part B coverage is admitted to the hospital, what will he or she will have to pay out of pocket?
a. Nothing
b. $500 deductible
c. 20% of the hospital and physician fees
d. More than $1000 deductible and 20% of all physician fees
d. More than $1000 deductible and 20% of all physician fees
- Since passage of the ACA in 2010, the following are true about payments changes except:
a. Beneficiaries no longer have cost sharing for preventive services
b. Providers in Medicare Advantage will be paid higher fees
c. The coverage gap known as the donut hole in Part D will be reduced over time
d. Hospitals have incentives to prevent readmission and coordinate care more effectively
b. Providers in Medicare Advantage will be paid higher fees
- All of the following about the Medicare Part D prescription medication benefit plan are true except:
a. Medicare Advantage plans include Part D coverage.
b. There are multiple companies that offer prescription plans from which the beneficiary must choose.
c. In 2019 the monthly premium for Part D coverage is approximately $30.
d. Beneficiaries have no out-of-pocket expense for each prescription fille
d. Beneficiaries have no out-of-pocket expense for each prescription fille
- All of the statements about Medicare are true except:
a. All of the funding for Medicare comes from federal taxes.
b. Durable medical equipment has no out-of-pocket cost to the patient.
c. Part B covers outpatient services and all physician professional fees whether inpatient or outpatient.
d. Patients are generally responsible for 20% of Part B bills.
a. All of the funding for Medicare comes from federal taxes.
- All of the statements about Medicaid are true, except:
a. Medicaid is jointly funded by federal and state governments.
b. Medicaid provides coverage for low-income people of all ages.
c. The coverage provided under Medicaid is the same in every state.
d. Long-term care for elderly and disabled people accounts for the largest proportion of Medicaid spending.
c. The coverage provided under Medicaid is the same in every state.
- Mr. B is an 82-year-old enrolled in your primary care clinic panel. His medical history includes moderate dementia and probable Alzheimer disease. He requires cues to bathe and dress but is otherwise independent in his activities of daily living. He cannot manage his medications and does not drive. His wife is his primary caregiver and has been providing 24-hour care supervision since he was found wandering outside by their neighbors. During your visit today, she admits that she is “feeling stressed” and at times “overwhelmed” with her caregiving responsibilities. She wants to know what options are available to help support her taking care of him. All of the following would be appropriate for Mr. B except:
a. Adult day program
b. Assisted living
c. Skilled nursing facility
d. In-home paid care provider
c. Skilled nursing facility
