Medicare
A U.S. Government health insurance program that covers:
- Most people age 65 and older
- Those who have permanent kidney failure
- Those who are disabled under strict Social Security rules and definitions
4 parts of medicare
(1) Hospital Insurance (Part A)
(2) Medical Insurance (Part B) (Voluntary)
(3) Medicare Advantage (Part C)
(4) Prescription Drug Insurance (Part D)
Hosptial Insruance–Part A (4)
(1) Inpatient hospital care
(2) Post-hospital extended care in a skilled nursing facility
(3) Post-hospital home health care
(4) Under certain conditions, hospice care
inpatient hospital care has up to ___ days for each “benefit period”
90
Post-hospital extended care in a skilled nursing facility has up to ___ days in each benefit period
100
post hospital home health services pays for the first ____ visits
100
The patient pays ___ of durable medical equipment costs
20%
Is there a deductible for hospice care for terminally ill patients
no
How much coinsurance does the benficiary have to pay for terminally ill hospice care?
- outpatient drugs : lesser of 5% of drug cost of $5
- inpatient respite care: 5% of the amount paid by medicare per day
What is the tax rate for employee and employers under Part A?
1.45%
What is the tax rate for self-employed individuals under Part A?
2.90%
There is a Federal Income Tax Deductionf for ___ of the hospital insurance self-employment tax
1/2
Medical Insurance (Part B) usually pays ___ of the approved charges for a doctor’s services after the patient pays the first ____ deductible
80%; $135
Medical Insurance (B) covers:
- Medical and surgical services
- Diagnostic tests and procedures that are part of the treatment
- Radiology and pathology services
- Treatment of mental illness which is limited
- X-rays
- Physician’s services
- Doctor’s office nurse
- Outpatient hospital care
- Physical therapy
- Ambulance trips
- Medical equipment
- Prosthetics
- Other services not covered under (Part A)
Medical Insurance (B) does NOT cover
Most routine physical exams and related tests
Most routine dental and foot care
Exams to prescribe and fit eyeglasses and most hearing aids and eyeglasses and hearing aids
Immunizations except annual flu shots or those required because of injury or immediate risk of infection
Cosmetic surgery except if an accidental injury or it is needed to improve function
Most prescription drugs
Custodial care at home or nursing home
Orthopedic shoes
How is medical insurance (b) financed?
through premiums
What is Medical Advantage (part C) required to provide?
the current Medicare benefit package except hospice services
Can Medical Advantage (c) offer supplemental services?
yes
Part C—required to pay for emergency servies without ______
prior authorization
Potential enrolles for Part C include:
- All persons eligible for Hospital Insurance (Part A), and
- Those who are enrolled in Medical Insurance (Part B)
What is the enrollment period for Part C?
First three months of eligibility in the first three months of the year
Medicare Advantage (Part C)
Medicare contracts with private managed care and fee-for-service organizations for services. Patients choose their benefits through Medicare fee-for-service or Medicare Advantage plans.
Medicare Supplement Insurance (AKA Medigap Insurance)
helps pay the deductibles and coinsurance incurred under Hospital Insurance (Part A) and Medical Insurance (Part B)
Will Medigap cover out of pocket expenses?
no
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Health Insurance39
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Health Maintenance Organization (HMO)15
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Flexible Spending Account24
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Health Savings Account41
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Health Reimbursement Arrangement (HRA)22
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Long-Term Care Plan19
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Sick Pay (Short Term Disability Plan)19
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Long Term Disability Insurance26
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VEBA Welfare Benefit Trust22
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Nonqualified Deferred Compensation21
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Social Security31
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Medicare25
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Traditional and Roth IRAs38
