New Deal
FDR ultimately drops effort to include a health insurance program in the original 1935 social security act
fair deal
in 1952, president truman abandoned his advocation of a universal health program and suggested a more limited health insurance plan that would cover social security beneficiaries
Great society
medicaid & medicare
Medicare
What is the single largest health insurance program in the US?
aged 65 or older, some disabled people, end-stage renal disease or ALS
Medicare covers who?
Medicare Assignment
many doctors and health care providers agree to accept the medicare-approved amount (the combination of what the beneficiary and medicare pay) as the total payment for their services.
Medigap insurance
-additional private insurance to deal with cost-sharing requirements
-must have Part A and Part B to be able to purchase this
medigap
-pays for patient share of healthcare charges (like co-pays, coinsurance, deductibles)
-must pay a monthly Medigap premium in addition to Part B premium
Medicare SELECT
- a medigap policy that requires a beneficiary to use specific hospitals and, in some cases, specific doctors to get full coverage
lower premium
What is the benefit of Medicare Select vs regular Medigap ?
Medicare Part C/ Medicare Advantage
-healthcare provided by private insurance companies approved by Medicare to administer Part A and Part B coverage.
True
Medicare Advantage Plans are not supplemental coverage. T/F?
hospice care
MA plans must cover all of the services that original Medicare cover except ______
PDPs
-private prescription drug plans
-only Rx coverage
MA-PDs
-covers healthcare services + Rx drugs
pharmacy & therapeutics (P&T) committee
PDP and MA-PD plans may establish formularies and must use a _________ to develop and regular review the formulary
Medication therapy management program. (MTM)
PDPs and MA-PDs must establish a _________.
hospital insurance trust fund
Medicare Part A is financed by who?
they or spouse worked 10 years, citizen or permanent resident, 65 years old
How does one qualify for Medicare part A?
Benefit period
-duration of time during which insurance pays for covered services.
60
The benefit period for medicare part A ends when a beneficiary hasn't received any hospital care (or skilled care in a SNF) for ______ consecutive days.
only deductible ; no copay
How much does beneficiary pay for the first 60 days?
1/4 of deductible
How much does beneficiary pay for days 61-90?
100% of costs
How much does beneficiary pay for days 91 and beyond?
lifetime reserve
- a total of 60 extra days a beneficiary can use once they have used 90 days
-they are responsible for 1/2 the deductible
only deductible; no copay
How much does beneficiary pay for first 20 days while in SNF?
1/8 of deductible
How much does beneficiary pay for days 21-100 while in SNF?
medicare part b
-this coverage includes physician services, outpatient hospital services, x-rays, pt,
-drugs and biologics that cannot be self administered