Health Insurance Exam- Unit 20 Medicare & Medicaid Exam Questions and Answers
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Course
Medicare Supplements
Institution
Medicare Supplements
Medicare & Medicaid - Answer--Medicare and Medicaid are two governmental programs that provide medical and health-related services to specific groups of people
-Although the two programs are very different, they are both managed by the Centers for Medicare and Medicaid Services, a division of the ...
Health Insurance Exam- Unit 20
Medicare & Medicaid Exam Questions
and Answers
Medicare & Medicaid - Answer--Medicare and Medicaid are two governmental programs
that provide medical and health-related services to specific groups of people
-Although the two programs are very different, they are both managed by the Centers
for Medicare and Medicaid Services, a division of the U.S. Department of Health and
Human Services.
-When an individual turns age 65 and has obtained fully insured status with Social
Security, Medicare becomes either their primary or secondary health insurance plan.
-Medicaid, on the other hand, is not an entitlement
-It's a means-tested health and medical services program for families and individuals
with low incomes and few resources.
medicare - Answer-*age 65 & over
*kidney failure (end-stage renal disease)
*received Social Security disability for at least 24 months
-----
-Medicare pays a large portion of the health care bill for persons who:
■ are age 65 or over;
■ have end-stage renal disease (kidney failure); or
■ have been receiving Social Security disability benefits for at least 24 months.
-In order to be covered by Medicare, an individual must be "fully insured" according to
Social Security
-Qualification requires accumulating at least 40 credits, which are earned by generating
a minimum amount of work-related income over at least the past 10 years and paying
Social Security (FICA) taxes.
-Medicare is federally funded by The Centers for Medicare & Medicaid Services (CMS),
which is a branch of the Department of Health and Human Services (HHS)
-Private healthcare insurance companies process medical claims for Medicare and are
known as Medicare Administrative Contractors (MAC).
-The initial enrollment for Medicare is a seven-month period that begins three months
before the month an individual turns 65, includes the month they turn 65, and ends
three months after the month they turn 65.
-Medicare coverage is divided into four parts.
■ Part A covers hospital, skilled nursing facility, hospice, and home health care.
, ■ Part B covers medical care provided by physicians and other medical services.
■ Part C covers health care delivered by managed care plans
■ Part D covers prescription drugs
medicare part A (enrollment/eligibility) - Answer-*automatic for persons age 65 (free) &
eligible for Social Security
*supported by payroll taxes
*premium charge for those not fully qualified for Social Security
medicare part A (hospital) - Answer--inpatient hospital coverage
-semi-private room & other usual charges necessary hospital care: meals, supplies,
medical services, drugs taken as an inpatient, etc.
does NOT cover:
-private duty nursing
-first 3 pints of blood (blood deductible)
-charges for a phone, TV, other non-medical services
-based on benefit periods rather than the calendar year
-benefit period begins when someone is admitted to the hospital & ends 60 days after
discharge
-if readmitted within 60 days after discharge, doesn't start a new benefit period but is a
continuation of the initial one
*For each benefit period, inpatient hospital coverage and cost-sharing amounts are as
follows:
-the patient pays a deductible, which changes annually (but remember that the
deductible applies per benefit period, not per calendar year);
-days 1 through 60—fully paid by Medicare (after the deductible); and
-days 61 through 90—Medicare pays most of the cost, and the patient pays a daily co-
pay amount
which changes each year.
-Lifetime reserve days' daily co-pay is double that of days 61 through 90. This co-pay
amount also changes each year.
***
*90 days per benefit period
*new benefit period starts 60 days after discharge
*additional 60 lifetime days
*deductible per benefit period--after deductible medicare pays 100% of first 60 days
*patient pays co-pay per day for days 61-90
*patient pays a higher daily co-pay for lifetime reserve days
skilled nursing facility (SNF) care (medicare part A) - Answer-*medical treatment
*following a hospital stay of at least 3 days
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