Medicare & Medicaid Flashcards

Terms Definitions
True/False: Medicare Part A is a compulsory hospitalization insurance that provides specified in-hospital and related benefits.
True/False: Medicare Part B is a voluntary program designed to provide supplementary medical insurance.
Which part of Medicare covers Physician services, Medical Services and supplies?
Part B
How is Medicare Part B financed?
By montly premiums from those who participate and and by tax revenues.
True/False: Inpatient hospital services are covered under Part B
Which part of Medicare covers Posthospital skilled nursing care, in an accredited care facility?
Part A
Which part of Medicare covers post hospital home health services, including nursing care, therapy and part time home health aids
Part A
Which part of Medicare covers Pysicians and surgeons services
Part B
Which part of Medicare covers Hospice benefits for the care of terminally ill patients
Part A
Which part of Medicare covers x-rays diagnostic lab tests and ambulance services
Part B
Which part of Medicare covers medical supplies and medical equipment rental
Part B
Which part of Medicare covers inpatient psychiatric care on a limited basis
Part A
Which part of Medicare covers physical and ocupational therapy
Part B
Which part of Medicare covers semiprivate room and board and nursing services
Part A
Under Medicare how long is a patients lifetime reserve for hospital coverage?
60 days
How long does a patient have to be hospitalized inorder to use lifetime reserve benefits?
Longer than 90 days in a benefit period
True/False: The lifetime reserve is a one time benefit that does not renew with a new benefit period
True/False: If a patient is hospitalized and taps into the reserve days, they are required to pay a higher copayment.
True ($534)
When does Medicare Part A become available?
When an individual turns 65 AND is automatically provided when they apply for SSI benefits.
True/False: No medicare benefits are provided for treatment in a skilled nursing facility beyond 100 days.
For Medicare Part A how many consecutive days must a patient be hospitalized before the cost of care in a skilled nursing facility can be covered?
3 days
True/False: Medicare Part A has a monthly premium
True/False: Medicare Part B has a premium AND a yearly deductible.
What year was Medicare established?
True/False: The State regulates Medicare
True/False: The Federal Government regulates Medicade
True/False: Medicare Advantage specialty plans provide more focused health care for people with specific conditions
Which part of medicade is known as the Medicare Advantage?
Part C
List 4 options (plans) that are available under Part C
1. Managed Care Plans
2. Preferred provider organizations
3. Private fee-for-service
4. Specialty Plans
True/False: Medicare advantage options replace the need for long term care insurance.
Page 311
What does a person need in order to be eligible for Medicare Advantage?
Must be enrolled in both Medicare Part A and B.
What is the goal of Medicaid?
To offer medical assistance to those whose income and resources are insufficient to meet the costs of necessary medical care.
True/False: Medicaid provides for custodial care or assisted care in a nursing home
What are the 4 qualifications for Medicaid?
1) Be at least 65, blind or disabled
2) Be a U.S. Citizen or permanent Resident Alien
3) Need the type of care that is provided only in a nursing
4) Meet certain asset and income tests.
Deficit Reduction Act of 2005
The look-back period has been extended to 5 years the home equity exemption has been limited to $750,000.
Under Medicaid Reform, what is a Health Opportunity Account (HOA)?
They give Medicaid beneficiaries a personal account that pays for health care services.
Direct Service Model
States give beneficiaries health spending accounts to buy a defined set of health care services.
Insurance Model
Medicaid beneficiaries receive a fixed budget to buy a health insurance product of their choice.
Florida Healthy Kids Corporation
Established in 1990 Uninsured children can obtain affordable health care coverage.
For how many days of skilled nursing facility care will Medicare pay benefits?
100 Days
True/False: Medicare Part B is a compulsory program.
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