Medicare - ANSWER established based on the need of health insurance for the elderly; was added as an Amendment to the Social Security Act (Title XVIII)
Medicare Eligibilities - ANSWER Requires that individuals have wo
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Medicare - ANSWER established based on the need of health insurance for the elderly; was added as an Amendment to the Social Security Act (Title XVIII)
Medicare Eligibilities - ANSWER Requires that individuals have worked at least 10 years in Medicare-covered employment or have paid taxes into the Medicare system, are US Citizens or permanent residents, and are at least 65 years old.
People under 65 may qualify for Medicare if they have End-Stage Renal Disease and require dialysis or a kidney transplat or if they recieve Social Security disability benefits (and have been for at least 24 months)
Medicare Enrollment and Spending - ANSWER Enrollment: 57 Million
Spending: $680 Billion
Medicare: Part A - ANSWER Hospital Insurance: Covers in-patient hospital care and other types of institutional care
Medicare Part A Benefit Period - ANSWER A deductible of $1316 is paid at the beginning of each period, which begins when a person enters the hospital and ends when a person has not been a patient in a hospital or skilled nursing facility for 60 consequtive days (90 day periods total)
60 day lifetime reserve days are available once the 90 days of the benefit period have been used
190 day lifetime supply of inpatient psychiatric care is separate from the benefit periods and reserve days
Individual also receives 100 days per benefit period at a skilled nursing facility care for short-term skilled care (not custodial care - should be care only provided in nursing homes) that can only be used if preceded by a hospital stay of at least 3 days
Hospice care (for patients with a life expectancy of less than 6 months that have waived the right to traditional treatment) is offered with very little patient cost-sharing (Pay 5% of Rx Drugs, repite care, grief counseling)
Medicare is not applicable if traveling outside of the US
Funding comes from payroll taxes from employees and employers
Medicare Part B - ANSWER Supplementary Medical Insurance (SMI)
Includes physician services, a variety of outpatient services, home health care, drugs that are not self-administered, and a variety of preventative services
Everyone eligible/receiving Part A can choose to purchase Part B; a 10% penalty on the premium is applied every year Part B is not purchased by an eligible individual
Everyone on Part B is charged a monthly premium that is automatically taken out of their social security check
Part B Cost Sharing - ANSWER Includes annual deductible of $183 plus 20% of approved charges (what Medicare is willing to pay)
Assignment: provider's charge equals Medicare;s approved charge (whatever Medicare says the charge will be)
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