PUBH 6012 Exam 3 Questions and Answers All Correct
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Course
PUBH 6012
Institution
PUBH 6012
PUBH 6012 Exam 3 Questions and Answers All Correct
Medicare Eligibility - Answer-Over 65 years of age & qualify for social security benefits
Disability Income for at least 24 months
End stage renal disease or ALS AND receiving SSDI
Must be US citizen or permanent legal resident
Four...
PUBH 6012 Exam 3 Questions and Answers All Correct Medicare Eligibility - Answer -Over 65 years of age & qualify for social security benefits Disability Income for at least 24 months End stage renal disease or ALS AND receiving SSDI Must be US citizen or permanent legal resident Four Parts of Medicare - Answer -1. Part A: Hospitals/Inpatient Services 2. Part B: Physicians/Outpatient Services 3. Part C: Managed Care Plans 4. Part D: Prescription Drug Plans Medicare Part A Benefits - Answer -Mandatory Enrollment (no premiums) Inpatient hospital care; skilled nursing facility (SNF) — post-acute care; hospice Long term care NOT covered Medicare Part A Financing - Answer -Mandatory 2.9% payroll tax —employers and employees pay 1.45% each (put into Hospital Insurance Trust Fund) Deductibles for each day in patient stay Cost sharing • Hospital care after 60 days • Skilled nursing facility care after 20 days Medicare Part B Financing - Answer -General federal tax revenue Monthly premium ($134/month minimum) Annual deductible ($183 in 2018) Cost sharing Medigap - Answer -Insurance coverage for out -of-pocket costs not covered by A and B. 10 strictly regulated plans All plans of the same letter offer the same benefit package so that beneficiaries can compare. Two Medigap plans (the "C" and "F" plans) cover both the Part A and the Part B deductible —"first- dollar" coverage for Medicare -covered services. Over 50% of people with Medigap choose Plan F Prices vary widely by lifestyle and geography Medicare Part C - Answer -Voluntary (25% enrolled) Combines part A,B, and usually D Patients enroll in private managed care plan Must be actuarially equivalent to traditional Medicare FFS Financed through Parts A, B, and D Essentially, Medicare pays the insurance company a capitated rate for covering the beneficiary Payments to MA averaged 114% of FFS in 2009 Medicare Part D - Answer -Created by Medicare Modernization Act of 2003, effective 2006 Voluntary 71% of beneficiaries were enrolled in 2018 Penalty if don't enroll when eligible and go without equivalent coverage 90% of all Medicare beneficiaries have creditable drug coverage Covers outpatient prescription drugs Offered through stand -alone prescription plans or Medicare Advantage Part D spending estimated to reach $88 billion in 2016, 15.5% of Medicare spending Medicare Part D Financing - Answer -Monthly premium (varies by plan - wide variation nationwide) Annual deductible (varies, capped at $415 for 2019) Sliding scale small additional premium if income more than $85,000/$170,000 (from $12.40 up to $77.40) Complicated cost sharing structure ("doughnut hole") Some subsidies for help with premiums and cost -sharing for those with incomes under 150% FPL with modest assets. Cost Drivers in Medicare - Answer -Costliest 5% of beneficiaries in Medicare FFS (traditional Medicare) account for 43% of total spending.
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