Basics 1
Which of the following types of care is excluded by both Part A and Part B of Medicare ?
a. most routine physical exams
b. emergency room services
c. ambulance services
d. occupational therapy.
a. most routine physical exams
Under part A in-patient hospitalization care, Medicare will generally cover procedures and treatments that are considered what?
Medically necessary
What are the five main types of Part C plans generally offered?
- Preferred Provider Organizations (PPO)
- Health Maintenance Organizations (HMO)
- Medical Savings Account (MSA)
- Private Fee For Service (PFFS)
- Special Needs Plans (SNP)
What does Medicare Part D cover?
Prescription drugs
What three broad categories of beneficiary does a Medicare Advantage Special Needs Plan (SNP) cover?
- Those with certain chronic or disabling diseases such as heart disease, diabetes, or HIV/AIDS
- Those living in a nursing home or certain other institutions.
- Those who qualify for both Medicare and Medicaid ("dual eligibles")
What is the usual coinsurance percentage that Medicare beneficiaries must pay for services covered under Part B of Medicare?
a. 0 percent
b. 20 percent
c. 50 percent
d. 80 percent
b. 20 percent
The current in-patient hospital deductible for 2023 is ?
$ 1600
Describe a PPO organization.
Preferred provider organizations (PPOs) are companies that have contracted with various hospitals, physicians, and other types of health-care providers to form a network that offers a complete range of care.
Do all Medicare Advantage plans include prescription drug coverage?
No! they do not. You must check to make sure it is included.
Do SNP plans include part D coverage?
Yes, they are all required to have part D coverage.
Ted turns age 65 in June. When does his initial enrollment period for Medicare begin?
a. February 1
b. March 1
c. June 1
d. July 1
b. March 1
If a patient has used all of their lifetime reserve days, during the remainder of the hospital stay, Medicare will pay ?
Nothing
A PPO organization will typically keep its members utilizing in-network providers how?
By making them cheaper then out of network providers.
The second phase of prescription drug coverage is called what?
The coverage phase.
Which Medicare Advantage plans always includes prescription drug coverage?
Special Needs Plans (SNP) always include prescription drug coverage
There are three main reasons why an individual may be eligible for Medicare. They are....?
- Ageing in at the age of 65
- Being on disability for 24 months
- End stage renal disease.
The lifetime limit on in-patient hospital stays for mental health concerns is ?
190 days
Referrals are typically not needed in what two types of Medicare Advantage organizations?
- PPO (Paid Provider Organization)
- PFFS (Paid Fee For Service)
What two things must a part D plan include in order to be a qualified part D plan?
1. All plans must meet certain specific minimums, although plans are allowed to offer additional coverage and services that exceed the minimum requirements if they choose.
2. The premium and cost sharing requirements are approved by CMS and must appropriately reflect the value of the plan..
What does the D in DSNP stand for?
Dual
There are five main things that Medicare part A cover. What are they?
- In-patient hospitalization
- skilled nursing facility care
- In home care
- hospice services
- blood.
For a skilled nursing facility, an in-patient benefit period starts on the day that a patient enters the hospital and ends when?
60 days after the patient is discharged
Referrals are typically needed in what type of Medicare Advantage organization?
An HMO
The first phase in a prescription drug plan is called what?
The deductible phase
What does the C in CSNP stand for?
Chronic