Study guide lesson 2 Medicare/Medicaid MBC_40

To qualify for Medicare, a disabled adult must have been receiving Social Security Disability (SSD) benefits for how long?

For more than 2 yrs.

What was Medicare part A deductible in 2007?

$992.00

What is the deadline to appeal a denied claim?

180 days.

The EPSDT program includes coverage for children younger than ___________?

21 yrs.

How long is each benefit period?

90 days long.

What is the time limit a Medicaid claim must be filed by?

95 days.

What does it mean when the physician is a "nonparticipating physician?"

A physician who chooses not to participate in a Medicare plan.

What does "accepting assignment" mean with Medicare?

A physician who has agreed to accept the allowed charge of a rendered service and payment in full.

Who is eligible for Medicare benefits?

Adults 65 yrs or older, adults with disabilities, Individuals who became disabled before the age of 18 yrs, an entitled spouse, a retired federal employee, Individuals with ESRP, or a permanent resident.

How often should the eligibility be checked for a Medicaid beneficiary?

Before each time they see the physician.

When filing a claim for a newborn baby boy, for mother Sally Smith, how should the name be listed on the claim?

Boy Sally Smith.

What are the three groups who are eligible for Medicaid?

Categorically needy, Medically needy, and Special groups.

Which organization is responsible for determining the type, amount, and scope of the services covered by Medicaid?

Each individual state.

How is the monthly premium for Medicare part B determined?

It is based on the annual income of the beneficiary.

Explain the different parts of Medicare and what they cover?

Medicare part A covers Hospital Insurance, Medicare part B covers Medical Insurance, Medicare part C (Medicare Advantage (MA) is a combination of part A & B but with expanded benefits, Medicare part D covers Medication Insurance.

After a Medicare part B beneficiary pays the deductible, what amount will Medicare pay?

Medicare pays 80% of the allowed amount and the patient will pay the remaining 20%.

Who determines the eligibility for Temporary Assistance for Needy Families (TANF)?

The county.

When a Medicare part A beneficiary is hospitalized, what will they have to pay?

The deductible for days 1-60, Coin-insurance for days 61-90, lifetime reserve for days 91-150.

Who pays for Medicaid?

The government and states share responsibility for funding.

What is the goal of Medicaid managed care?

To reduce service fragmentation, increase access to care, reduce cost, and stimulate the development of more appropriate use of service.