Medicare Chapter 4 Flashcards
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Questions and Answers

What enacted Medicare?

Title XVII of the Social Security Act of 1965, implemented in 1966.

What created Part C of Medicare?

Balanced Budget Act of 1997.

What created Part D?

Medicare Modernization Act (MMA) of 2003.

To be eligible for Medicare, you have to be?

<p>Age 65 and older (and eligible for social security or railroad retirement benefits), permanent disability, or end-stage renal disease.</p> Signup and view all the answers

Which has higher spending, beneficiaries over 65 or ESRD beneficiaries?

<p>ESRD.</p> Signup and view all the answers

Medicare Part A services do what?

<p>Inpatient hospital, long-term care, skilled nursing services, home health services, and hospice care.</p> Signup and view all the answers

Medicare Part B services do what?

<p>Physician services, medical services, and medical supplies.</p> Signup and view all the answers

In Medicare Part B, what coverage is under medical services?

<p>Imaging, clinical laboratory, hospital outpatient department, ambulatory surgery facility, physical/occupational/speech therapy.</p> Signup and view all the answers

In Part B, the beneficiary pays monthly premiums plus annual deductible and coinsurance.

<p>True</p> Signup and view all the answers

What are services not covered by Parts A and B?

<p>Dental care or dentures, vision care, hearing aids, routine foot care, acupuncture, long-term care (beyond Part A limits).</p> Signup and view all the answers

Medicare Part D services include?

<p>Covers outpatient prescription medications.</p> Signup and view all the answers

In Medicare Part D, the beneficiary pays what?

<p>Monthly premium, deductible, and copayments.</p> Signup and view all the answers

What is Part C of Medicare also known as?

<p>Medicare Advantage (MA).</p> Signup and view all the answers

What is MA?

<p>Medicare's managed care program.</p> Signup and view all the answers

What does MA do?

<p>Limited beneficiary's out-of-pocket costs and offers expanded scope of services beyond Parts A and B (e.g., vision care, hearing aids).</p> Signup and view all the answers

Beneficiaries usually must stay within the plan's provider network with MA.

<p>True</p> Signup and view all the answers

In Medicare Part C, what are beneficiaries responsible for?

<p>Paying monthly premium plus co-payments for specific services, as defined by each plan.</p> Signup and view all the answers

What is the total amount of Medicare benefit payments as of 2015?

<p>$632 billion.</p> Signup and view all the answers

Medicare spending increases by age.

<p>True</p> Signup and view all the answers

What is the most expensive time for medical insurance?

<p>Death.</p> Signup and view all the answers

Medicare spending varies by state.

<p>True</p> Signup and view all the answers

What are the FFS Medicare beneficiary responsibilities?

<p>Premiums depend on income (Part B and D) and plan chosen (Part D); deductible, coinsurance, and/or copayment depend on service (Part A, B, D) and plan chosen (Part D); FFS Medicare beneficiaries do not have an annual out-of-pocket limit.</p> Signup and view all the answers

What are some services performed by Medicare Part A?

<p>Hospital inpatient care, long-term care, skilled nursing facility, home health, hospice.</p> Signup and view all the answers

What are some services performed by Medicare Part B?

<p>Medical services, clinical laboratory services, home health, outpatient hospital services.</p> Signup and view all the answers

What is Medigap?

<p>A supplementary coverage that can be purchased to cover things not under Medicare.</p> Signup and view all the answers

If a person is low income and on Medicare, can they also have Medicaid as supplementary coverage?

<p>True</p> Signup and view all the answers

Medicare has a single funding source.

<p>False</p> Signup and view all the answers

For each Medicare part, there is a different mix of funding sources.

<p>True</p> Signup and view all the answers

Study Notes

Medicare Overview

  • Medicare was enacted under Title XVII of the Social Security Act in 1965, implemented in 1966.
  • The Balanced Budget Act of 1997 established Medicare Part C.
  • Medicare Part D was created by the Medicare Modernization Act (MMA) of 2003.

Eligibility Criteria

  • Individuals aged 65 and older, those with permanent disabilities, and patients with end-stage renal disease (ESRD) qualify for Medicare.
  • Higher spending is associated with ESRD beneficiaries compared to those over 65.

Medicare Part A Services

  • Covers inpatient hospital care, long-term care, skilled nursing services, home health services, and hospice care.

Medicare Part B Services

  • Includes physician services, medical services, and medical supplies.
  • Medical services in Part B encompass imaging, clinical laboratories, outpatient hospital departments, and therapy services.

Cost Structure in Medicare

  • Beneficiaries in Part B must pay monthly premiums, an annual deductible, and coinsurance.
  • Services not covered by Parts A and B include dental care, vision care, hearing aids, routine foot care, acupuncture, and long-term care beyond Part A limits.

Medicare Part D

  • Focuses on covering outpatient prescription medications.
  • Beneficiaries are responsible for a monthly premium, deductible, and copayments.

Medicare Advantage (Part C)

  • Known as Medicare Advantage (MA), it is a managed care program that limits out-of-pocket costs and offers expanded services beyond Parts A and B, such as vision and hearing care.
  • Beneficiaries typically must stay within their plan's provider network.

Financial Aspects

  • Total Medicare benefit payments reached $632 billion in 2015.
  • Medicare spending tends to increase with age, peaking around the time of death.
  • Medicare spending varies by state.

Fee-for-Service (FFS) Responsibilities

  • FFS beneficiaries have varying premiums based on income and selected plans.
  • They may incur deductibles, coinsurance, or copayments depending on the service received.
  • No annual out-of-pocket limit exists for FFS Medicare beneficiaries.

Supplementary Coverage

  • Medigap plans offer supplemental coverage for services not covered by Medicare.
  • Low-income individuals on Medicare may also qualify for Medicaid as supplementary coverage.

Funding of Medicare

  • Medicare is funded through multiple sources: 42% from federal general tax revenues, 37% from federal payroll taxes, 13% from beneficiary premiums, and 8% from other sources.
  • Each Medicare part has a distinct mix of funding sources.

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Test your knowledge of Medicare with these flashcards from Chapter 4. Learn about the history of Medicare, including key legislation and eligibility criteria. Perfect for students preparing for exams or individuals wanting to understand Medicare better.

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