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Flashcards in Medicare/Medicaid Deck (40)
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1

Medicare made up of:

Part A (Inpatient)
Part B (Outpatient)
Part C (Medicare Advantage)
Part D (Prescription Drug Benefit)
Medicaid

2

What is Medicare's share of the federal budget?

15%

3

What is covered in Medicare part A:

Home health care
Hospice care
Inpatient care in hospitals
Inpatient care in critical access hospitals
SNF

4

How many days are covered under Medicare part A in a SNF?

100 days

5

Who is covered under Medicare?

People age 65 or older
Some people under age 65 with disabilities
People with End-Stage Renal Disease (ESRD)

6

When does a benefit period begin?

begins the day you're admitted as an inpatient in a hospital or SNF

7

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.”

8

Premium for part A:

$0 for most people worked more than 40 quarters
Premiums if worked less than 40 quarters

9

What is the deductible for each benefit period?

$1316

10

Days 1-60 hospital:

$0 coinsurance

11

Dags 61-90 hospital:

$329 coinsurance per day

12

Days 91-150 hospital:

lifetime reserve days
$658 per day
Up to 60 days over patient’s lifetime

13

Beyond lifetime reserve days hospital:

all costs borne by patient

14

Amount of SNF deductible?

no deductible

15

Days 1-20 SNF:

$0 coinsurance

16

Days 21-100 SNF:

$164.50 coinsurance per day

17

Days 100+ SNF:

All costs borne by patient

18

Home Health cost per benefit period:

No deductible
20% of the Medicare approved amount for durable medical equipment

19

Hospice cost per benefit period:

$0 for hospice care

20

Cost outpatient rehab:

20% coinsurance based on the Medicare Physician Fee Schedule (MPFS)

21

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

22

Social Security tax rate:

12.4%
6.2% by employer and employee

23

When do you no longer pay the social security tax?

When your gross pay exceeds $118,500 (in 2017)

24

PPS

Prospective Payment System
Medicare sets the price

25

IRF requirements:

Patients must receive 3 hours of PT-OT-SLP (or any combination thereof) per day at least 5 days per week

26

SNF requirement:

3 day Part A stay in an acute hospital bed
Skilled level of care still required (nursing, rehab)

27

What is covered under Medicare part B?

Physician services
Outpatient hospital care
Home health (if patient is not homebound)
Covered supplies if medically necessary

28

Cost of Medicare part B?

Annual deductible of only $183.00 in 2017
$109.00 monthly premium in 2017

29

What is means tested?

Is tied to annual income

30

What is Medicare part B funded by?

Enrollee premiums
Allocations from general taxation