HI EVREBODY
What are the Standard and Reduced
Premium HI amounts for 2023
$506 and $278
The base premium amount for SMI in 2023
What is $164.90
QMB, SLMB, QI, and QDWI
What are the four types of State Buy-In
The IEP, GEP, and SEP
What are voluntary enrollment periods
Cancellation of Medicare coverage before it becomes effective.
What is a Withdrawal (Refusal)
Up to 6 months for Premium-Free HI
What is the maximum retroactivity
Of the following, it’s NOT covered by Part B:
Outpatient Hospital Services, Hospice Care, Physician Services
What is Hospice Care
It’s the Primary Coverage when entitled to both Medicare and Medicaid
What is Medicare
Required when an individual is applying during a SEP for proof of an EGHP
What is the CMS-L564
Entries needed when refusing Part B because of EGHP:
MCS SCREEN:
TYPE OF ACTIO- SMI: __
1. ENROLL
2. REFUSE
Eligible for Medicaid (Y/N) ___
EQUITABLE RELIEF (Y/N) __ DEEMED IEP ____
Covered under a group health care plan based on employment (Y/N) ______
What are ‘2’ and ‘Y’
Attained age 65, be a US Resident, be a US Citizen or a LAPR with 5-years continuous residence in the US, enrolled/enrolling in SMI, enroll during a prescribed period, and be ineligible under any other provision
What are the requirements for Premium-HI
It’s a 10% increase for every 12 months that have elapsed after a person’s IEP through the month of GEP enrollment
What is the Part B Premium Surcharge
Under this State Buy-in option, the state would cover both Part A & B premiums, deductibles, and co-insurance
What is QMB
(Qualified Medicare Beneficiaries)
Takes precedence when the IEP and SEP overlap
What is the IEP
The end of the month following the month the individual submits the CMS-1763
What is the termination effective date
An uninsured person who may qualify for Premium-Free HI on an insured NH
Who is a Spouse
A provision that requires individuals to pay a higher Medicare Premium due to higher income
What is IRMAA
(Income Related Medicare Adjustment Amount)
When an application for Part B can be filed to establish eligibility for state buy-in
What is any time (doesn’t have to be in an enrollment period)
MCS Medicare Enrollment screens which will be displayed for this claimant:
MCS Screen :
Filing for Medicare only, restricting monthly benefits(Y/N): ___
Will Medicare apply: __ 1. Yes 2. No 3. Already
enrolled on another SSN
What is None; they are covered on another SSN
This is terminated by death, the last day of the 36th month after a transplant, or last day of the 12th month after dialysis terminates
What is ESRD Medicare (R-HI & R-SMI)
In general, it’s all the Room and Board costs for the first 60 days of an in-patient stay.
What is covered by Medicare Part A
This extends from January 1st through March 31st of each calendar year
What is the General Enrollment Period (GEP)
The initial month 3rd Party Buy-In of Medicare Part B began?
SMI 3PRT Start- 02/2010 Stop 05/2010 Codr-270-State billing
Start-06/2010 Code-170 Category -State Billing
What is 02/2010; State payer changed in 06/2010
Month in which Medicare Part B became effective:
FACT Screen
SMI-AGE Start 12/2016 Basis-Age Period-IEP Filing
08/2016
What is 12/2016
Premium penalty imposed with 12 month late enrollment to Medicare Part D
What is 12% (1% for each month)