Medicare

Question 1

Who qualifies for Medicare?

Answer 1

-Pts 65+
=Pts with certain disabilities
Everyone with ESRD, amyotrophic lateral sclerosis (ALS)

Question 2

What changed on the Medicare card?

Answer 2

SSN is no longer used as ID

Question 3

How many people does Medicare cover?

Answer 3

52 million Americans

Question 4

When was Medicare enacted?

Answer 4

1965

Question 5

When was drug benefit added?

Answer 5

1988–but repealed in 1989 and added again in 2000/passed in 2002/implemented in 2006

Question 6

Part A covers what?

Answer 6

Hospital

Question 7

Part B covers what?

Answer 7

Medical equipment, outpatient services, preventative services, ambulance

Question 8

Part C is what?

Answer 8

Combined A & B - Medicare Advantage Plan

Question 9

Part D is what?

Answer 9

Drugs (those that aren’t included in Part A/B)

Question 10

Who has to pay for Part A coverage?

Answer 10

People who haven’t worked for 10 full years

Question 11

How doe Medicare pay hospitals?

Answer 11

Based on average cost to treat the condition

Question 12

What’s the Hospital stay deductible?

Answer 12

$1340

Question 13

When do patients have to start paying for hospital (what day)?

Answer 13

After day 60–$335 per day

Question 14

When does a benefit period end?

Answer 14

60 days without service in a row (so if readmitted within 60 days, same benefit period)

Question 15

How many days do you have to spend in hospital before SNF?

Answer 15

3 days

Question 16

How long can you stay in SNF before costs aren’t covered at all?

Answer 16

100 days

$0 for first 20 days

Question 17

Are prescription drugs in SNF covered?

Answer 17

Nope (part D)

Question 18

Do you have to have a prior hospitalization to qualify for home health coverage?

Answer 18

Nope

Question 19

Is 24-hour home nursing care covered?

Answer 19

Nope

Question 20

Is hospice care covered?

Answer 20

Yep - but no treatments to cure

Question 21

When is home health aid/homemaker services covered?

Answer 21

With hospice care

Question 22

When does Part A cover outpatient Rx drugs?

Answer 22

Hospice care

Question 23

T/F: Part B is required`\

Answer 23

False! You can opt out

Question 24

Is Part B free?

Answer 24

Nah - pay based on income

Question 25

How much does Part B cover?

Answer 25

80% after deductible

Question 26

Is LTC covered by Medicare Part B?

Answer 26

No

Question 27

Is chiropractor covered by Medicare part B?

Answer 27

Yep

Question 28

Is visual covered by Medicare Part B?

Answer 28

Optometrist is--but not eye exams to cover glasses

Question 29

Is dental covered by Medicare Part B?

Answer 29

No

Question 30

Is podiatrist covered by Medicare Part B/

Answer 30

Yep

Question 31

Which drugs are covered by Part B?

Answer 31

``` Injectables in doctor's office Drugs administered through Part-B covered DME (nebulizer or insulin pump and BG testing supplies) EPO for ESRD Oral anti-cancer Oral anti-emetics w/cancer Oral immunosuppressive w/transplant PEN and enteral nutrition ```

Question 32

If a med is used in the hospital, which Medicare covers it?

Answer 32

A

Question 33

If a med is used in the doctor's office, which Medicare covers it?

Answer 33

B

Question 34

If a med is used at home, which Medicare covers it?

Answer 34

D

Question 35

What is Medigap?

Answer 35

A medicare supplement to cover deductibles for Part A and B, and other preventative care (can cover some without covering at all--different plans)

Question 36

What is eligibility for Part C?

Answer 36

Have Medicare A & B Live in service area Do not have ESRD

Question 37

What is covered in Part C sometimes that's not in A/B?

Answer 37

Prescriptions Vision Dental hearing

Question 38

What is an HMO?

Answer 38

Can only go to doctors, specialists or hospitals on the plan's list

Question 39

What is PPO?

Answer 39

Pay less if you use in-network providers | Out of network costs more

Question 40

What is PFFS?

Answer 40

May go to any Medicare doctor that accepts plan's payment - will have contracted physicians Insurance plan decides how much it will pay and what you pay

Question 41

What's the advantage of Medicare Advantage?

Answer 41

- Premiums/copays might be lower - May offer extra benefits - May have prescription benefits - Coordinate care - Easy billing - No Medigap needed

Question 42

What's the late enrollment penalty?

Answer 42

1% per month of every patient who was eligible but no enrolled & didn't have credible drug coverage

Question 43

Part D has a monthly premium?

Answer 43

True

Question 44

Part D has annual deductible?

Answer 44

True (sometimes)

Question 45

Part D has coinsurance?

Answer 45

True

Question 46

Part D has coverage limit?

Answer 46

True (then donut hole)

Question 47

When does patient reach donut hole?

Answer 47

$3750

Question 48

When does catastrophic coverage start?

Answer 48

$7509

Question 49

How much TrOOP do patients have to pay before deductible met?

Answer 49

$5000

Question 50

What percent of cost do beneficiaries pay now in the donut hole?

Answer 50

35% of brand | 44% of generic

Question 51

What is the Low-Income Benefit?

Answer 51

Extra assistance based on FPLs

Question 52

What does the CMS online tool do?

Answer 52

Provide lists of formularies/plans available to patients based on their drug list and preferred pharmacy

Question 53

How can you enroll in a PDP?

Answer 53

-call them mail in form -online (PDP's website)

Question 54

T/F: Pharmacies can distribute PDP marketing materials and enrollment forms

Answer 54

True

Question 55

T/F: Pharmacies can distribute MA or MA-PDP marketing materials and enrollment forms

Answer 55

False! No enrollment forms

Question 56

T/F: A pharmacy can collect enrollment applications

Answer 56

False

Question 57

T/F: Pharmacies can provide health screenings while distributing PDP enrollment information

Answer 57

False! Health screenings are prohibited marketing activities