2022-09-28T00:57:18+03:00[Europe/Moscow] en true <p>New Deal</p>, <p>fair deal</p>, <p>Great society</p>, <p>Medicare </p>, <p>aged 65 or older, some disabled people, end-stage renal disease or ALS</p>, <p>Medicare Assignment</p>, <p>Medigap insurance</p>, <p>medigap</p>, <p>Medicare SELECT</p>, <p>lower premium</p>, <p>Medicare Part C/ Medicare Advantage</p>, <p>True</p>, <p>hospice care</p>, <p>PDPs</p>, <p>MA-PDs</p>, <p>pharmacy &amp; therapeutics (P&amp;T) committee </p>, <p>Medication therapy management program. (MTM)</p>, <p>hospital insurance trust fund</p>, <p>they or spouse worked 10 years, citizen or permanent resident, 65 years old</p>, <p>Benefit period</p>, <p>60</p>, <p>only deductible ; no copay</p>, <p>1/4 of deductible</p>, <p>100% of costs</p>, <p>lifetime reserve</p>, <p>only deductible; no copay</p>, <p>1/8 of deductible</p>, <p>medicare part b</p> flashcards
Medicare

Medicare

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  • 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