Flashcards in Medicare/Medicaid Deck (40)
Medicare made up of:
Part A (Inpatient)
Part B (Outpatient)
Part C (Medicare Advantage)
Part D (Prescription Drug Benefit)
What is Medicare's share of the federal budget?
What is covered in Medicare part A:
Home health care
Inpatient care in hospitals
Inpatient care in critical access hospitals
How many days are covered under Medicare part A in a SNF?
Who is covered under Medicare?
People age 65 or older
Some people under age 65 with disabilities
People with End-Stage Renal Disease (ESRD)
When does a benefit period begin?
begins the day you're admitted as an inpatient in a hospital or SNF
When does a benefit period end?
when you haven't received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row.”
Premium for part A:
$0 for most people worked more than 40 quarters
Premiums if worked less than 40 quarters
What is the deductible for each benefit period?
Days 1-60 hospital:
Dags 61-90 hospital:
$329 coinsurance per day
Days 91-150 hospital:
lifetime reserve days
$658 per day
Up to 60 days over patient’s lifetime
Beyond lifetime reserve days hospital:
all costs borne by patient
Amount of SNF deductible?
Days 1-20 SNF:
Days 21-100 SNF:
$164.50 coinsurance per day
Days 100+ SNF:
All costs borne by patient
Home Health cost per benefit period:
20% of the Medicare approved amount for durable medical equipment
Hospice cost per benefit period:
$0 for hospice care
Cost outpatient rehab:
20% coinsurance based on the Medicare Physician Fee Schedule (MPFS)
What is Medicare Part A funded by?
a federal payroll 2.9% tax paid by both employees and employers
1.45% paid by employer and employee
Social Security tax rate:
6.2% by employer and employee
When do you no longer pay the social security tax?
When your gross pay exceeds $118,500 (in 2017)
Prospective Payment System
Medicare sets the price
Patients must receive 3 hours of PT-OT-SLP (or any combination thereof) per day at least 5 days per week
3 day Part A stay in an acute hospital bed
Skilled level of care still required (nursing, rehab)
What is covered under Medicare part B?
Outpatient hospital care
Home health (if patient is not homebound)
Covered supplies if medically necessary
Cost of Medicare part B?
Annual deductible of only $183.00 in 2017
$109.00 monthly premium in 2017
What is means tested?
Is tied to annual income