Test 2 Medicare

Question 1

Who is medicare for?

Answer 1

• those who pay social security and are 65 and older

- some pts with disability under 65, some end stage renal disease patients

Question 2

Part A

Answer 2

- Hospital insurance
skilled nursing facility 
- hospice care 
- some limited home health care
- Automatic eligibility 
- for non-SS people, can buy into the system but has late enrollment policy

Question 3

Part B

Answer 3

• Supplemental-physician insurance, voluntary
• income adjusted monthly premium
• late fee of 10% penalty for each 12 months that you don’t apply
• pt pays 20% of coinsurance

Question 4

Part C

Answer 4

• Medicare advantage offered by private insurance companies
• aka Medigap
• cost as much as part B premium
• have to sign up for part B to sign up for part C

Question 5

Part D

Answer 5

• Prescription drug insurance, voluntary
• eligible if you have part A
• ## must apply within 2 months of eligibility to avoid late fee

Question 6

define benefit period

Answer 6

• begins day you go to a hospital or SNF
• ends when have not received any hospital or SNF care for 60 days in a row
• deductibles are for each benefit period

Question 7

Part A Hospital Stay

Answer 7

• deductible for first 60 days
• days 61-90, pay $X amount per day
• over 90d, pay $X amount per lifetime reserve day (can have 60 over lifetime)

Question 8

Part A Skilled Nursing Facility

Answer 8

• pt doesn’t pay for day 1-20
• 21-100 days pay $164 per day
• day 101 and over, pt pays all costs

Question 9

Low Income Patients

Answer 9

_ <= 135% FPL: No premiums, deductible, gap in coverage

- 136-150% FPL: Plan benefits on a sliding scale