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?
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Which has higher spending, beneficiaries over 65 or ESRD beneficiaries?
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Medicare Part A services do what?
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Medicare Part B services do what?
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In Medicare Part B, what coverage is under medical services?
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In Part B, the beneficiary pays monthly premiums plus annual deductible and coinsurance.
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What are services not covered by Parts A and B?
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Medicare Part D services include?
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In Medicare Part D, the beneficiary pays what?
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What is Part C of Medicare also known as?
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What is MA?
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What does MA do?
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Beneficiaries usually must stay within the plan's provider network with MA.
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In Medicare Part C, what are beneficiaries responsible for?
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What is the total amount of Medicare benefit payments as of 2015?
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Medicare spending increases by age.
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What is the most expensive time for medical insurance?
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Medicare spending varies by state.
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What are the FFS Medicare beneficiary responsibilities?
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What are some services performed by Medicare Part A?
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What are some services performed by Medicare Part B?
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What is Medigap?
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If a person is low income and on Medicare, can they also have Medicaid as supplementary coverage?
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Medicare has a single funding source.
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For each Medicare part, there is a different mix of funding sources.
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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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Description
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.
