Medicare & Medicare Advantage
How much is Medicare Part A premium for people who are not eligible for premium-free hospital insurance?
$471 per month
Who is automatically enrolled in Medicare Part A?
Seniors
What are some reasons seniors might consider medicare advantage over original medicare?
Some MA have $0 premiums No need to enroll in or pay Medigap premiums Avoid cost-sharing in Parts A and B MA has max annual out of pocket payments Offers additional benefits (dental, drug, vision)
What is hospice care?
Special way of caring for people for are terminally ill Have person to help patient with ADL
What does Medicare Part A cover?
hospitalization, hospice care, home healthcare services, skilled nursing facility (SNF), drugs during hospitalization
What is Medicare Part C?
(Medicare Advantage) Managed Care Plan (MCP)
Who is eligible for medicare?
- Older adults 65+ - Individuals below 65 with end-stage renal disease - People with amyotrophic lateral sclerosis - People living with long-term disability
What was the original medicare plan?
FFS plan managed by federal government
What is the funding source for Medicare Part A?
Federal Hospital Insurance Trust Fund
What is medicare?
Federal health insurance program administered by the centers for medicare and medicaid services (CMS)
Where do medicare revenues primarily come from?
General revenues Payroll taxes Premiums paid by beneficiaries
What could Medicare Advantage plans be? What are plan premiums for Part C?
HMO, PPO Can vary from $0 to $481/month
What are some negatives to having traditional medicare?
Has annual out of pocket cost Part A after 60 days has deductible Part B has coinsurance 20%
What do higher income taxpayers pay on earnings?
Higher payroll tax (2.35%)
What is a negative of Medicare Advantage?
Restrictive on provider choice and services Must be in accordance with managed care plan rules
What is Medicare Part C/MA run by?
private insurance companies
What is the way that the medicare plan measures the use of hospital and SNF services?
uses a benefit period
What are the 4 parts of medicare?
Part A: Hospital Insurance Part B: Medical Insurance Part C: (Medicare Advantage) Managed Care Medicare Part D: Prescription Drug Coverage
What part of medicare covers FREE annual wellness visits?
Part B
What do patients have in Medicare Part B regarding out of pocket?
20% coinsurance - patient pays 20% after deductible is met
Under Medicare Part A how many days of hospital coverage do you have?
60 days
What does Medicare pay each month to Part C plans? What is this for?
Capitated payment (per enrollee) Provision of Part A and B benefits
What is going on with the hospital insurance trust fund?
Could be depleted by 2026 Cost of healthcare is increasing Number of people covered by medicare increasing Number of workers per beneficiary decreasing
What are the two types of medicare coverage? What is the most popular?
Medicare Advantage + Medicare FFS Medicare FFS
What does MA-PD plans stand for?
Medicare Advantage Prescription Drug Plans
What do Medicare Part C plans have? What do some Part C plans cover?
Annual cap on out-of-pocket expenses Prescription drugs, vision, dental, hearing benefits
Where does Medicare cover post-acute care?
At a medicare certified SNF (skilled nursing facility) following an inpatient hospitalization for at least 3 consecutive days
What is the benefit of enrolling in original medicare?
Beneficiaries have choices in selecting providers
What does Medicare Part C cover?
Benefits under original medicare (part A/B)
When does a benefit period begin? When does benefit period end?
Day patient goes into hospital. After the patient has not received any inpatient hospitalization care/SNF for 60 days in a row
What is enrollment for Medicare Part B?
Enrollment is NOT automatic Premium is $148.5 Deductible $203 for year 2021
For Medicare Part B, what are premiums based on?
Income
What is the basis of Part B & D?
Income based
What does Medicare Part C plan eliminate?
Need for Medigap policies
Is there a premium for most seniors on Medicare Part A?
No, not for 99% of enrollees They or their spouses have contributed payroll taxes into the social security system for at least 10 years
What are the Medicare Coverage options?
Original Medicare (Part A/B) alone or with medigap Medicare Advantage (Part C) Original Medicare & Prescription Drugs with or without Medigap
Who does medicare provide coverage to?
Over 60 million older adults AND those with long term disability
What parts of medicare constitute original medicare? What do the majority of Medicare beneficiaries enroll for?
Parts A and B Original Medicare
What is the requirement for hospice care?
Patient has less than 6 months to live Physician has to certify patient is terminally ill
What is the Federal Hospital Insurance Trust Fund financed through? What percent? What happens if you are self employed?
Payroll taxes 2.9% payroll taxes shared equally by employers and employees Responsible for paying 2.9% of your earnings to Federal Hospital Insurance Trust Fund
What does Medicare Part B cover?
Physician services, outpatient renal dialysis, ambulatory care, emergency care, lab services, rx drugs at doctors office, medical supplies, annul wellness visits
What is the funding source for Medicare Part B & D?
Premiums and general revenues (individual income tax, corporate taxes, excise taxes)
When must a patient be admitted to a SNF? What must the reason for admission to a SNF be related to?
Within 30 days of discharge from the hospital Same condition for which patient was hospitalized
Are SNF covered services fully paid for?
Yes, during first 20 days beyond that cost-sharing applies
What do the beneficiaries pay under original medicare plan?
deductible and co-insurance for covered services
In the patient cost-sharing of Medicare Part A, what is the patient out of pocket cost for days 1-60 in hospital? After 150 days?
deductible then nothing Full cost of hospital stay
When is the benefit period for Medicare Part A? When does the benefit period end?
first 60 days 60 days after discharge
What characteristic encompasses the highest percentage of the medicare population?
functional impairment (ADL limitation - activity of daily living)
What is the Medigap among beneficiaries in traditional medicare?
gap on hearing aids, vision, etc
