Medicare

Part A / Part B

100

What is covered by Part A?

Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition. If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.

200

What does Part B cover?

Part B covers 2 types of services Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

300

What is the cost of Part B?

The standard Part B premium amount is $121.80 (or higher depending on your income). However, most people who get Social Security benefits will continue to pay the same Part B premium amount as they paid in 2015. This is because there wasn't a cost-of-living increase for 2016 Social Security benefits. You'll pay a different premium amount if: You enroll in Part B for the first time in 2016. You don't get Social Security benefits. You're directly billed for your Part B premiums. You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $121.80.) Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount. If you're in 1 of these 5 groups, here's what you'll pay: If your yearly income in 2014 (for what you pay in 2016) was You pay each month (in 2016) File individual tax return File joint tax return File married & separate tax return $85,000 or less $170,000 or less $85,000 or less $121.80 above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $170.50 above $107,000 up to $160,000 above $214,000 up to $320,000 Not applicable $243.60 above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 and up to $129,000 $316.70 above $214,000 above $428,000 above $129,000 $389.80 Get more information about your Part B premium from Social Security [PDF, 341 KB]. Part B deductible & coinsurance You pay $166 per year for your Part B deductible. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment. Note In 2016, there may be limits on physical therapy, occupational therapy, and speech language pathology services. If so, there may be exceptions to these limits. Find out what Part B covers. Find out what you pay for Part B covered services. Find someone to talk to Find someone to talk to in your state Go Is your test, item, or service covered? Search Medicare.gov for covered items type your test, item, or service here Go Footer

400

What is the Part B deductible?

You pay $166 per year for your Part B deductible. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment. Note In 2016, there may be limits on physical therapy, occupational therapy, and speech language pathology services. If so, there may be exceptions to these limits.

500

****DAILY DOUBLE**** What is the Exact dollar amount you need to spend to enter to Coverage Gap??

What is $3,310.00 The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2016, once you and your plan have spent $3,310 on covered drugs, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Part C

100

You must have A & B to be eligible for this plan:

What is Medicare Advantage

200

What is PART C?

Part C - Medicare Health Plans (Medicare Advantage plans must cover all Part A and Part B services) Health Maintenance Organizations (HMOs) (some also include Part D) Preferred Provider Organizations (PPOs) (some also include Part D) Private Fee-for-Service Plans (PFFS) (some also include Part D) Special Needs Plans (SNPs) (always include Part D) Medical Savings Account Plans (MSAs) (do not include Part D) Employer or Union Group Plans

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What is Part C also known as?

-Also called Medicare Part C -Medicare coverage provided by private insurance companies -Dental, vision, and prescription drug coverage may be available -$0 premium plan options may be available*

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What does Medicare Advantage cover?

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.

500

What is consistent with an advantage plan, a Medicare prescription drug plan, and a Medicare supplement plan?

They are all Medicare plans!!

Part D

100

What is True or False - Coverage of Medicare Part D benefits is provided by private companies

True - Medicare pays a share of the program costs What are those plans? The types of Part D plans are: Stand-alone Prescription Drug Plans (PDP) Medicare Advantage-Prescription Drug (MA-PD) Plans: MA health plans that also cover Part D prescription drugs. Cost-PD Plans Medicare health plans that cover Part D prescription drugs as an optional supplemental benefit. http://www.ahipmedicaretraining.com/course/view.php?id=107&page=4121

200

Can Medicare Advantage HMO or PPO may only obtain Part D benefits in a standalone PDP?

Medicare Advantage HMO or PPO may only obtain Part D benefits through their plan. They may not enroll in a standalone PDP. (Employer group plan enrollees may have additional choices.)

300

What are the types of Part D plans?

The types of Part D plans are:  Stand-alone Prescription Drug Plans (PDP)  Medicare Advantage-Prescription Drug (MA-PD) Plans: • MA health plans that also cover Part D prescription drugs.  Cost-PD Plans • Medicare health plans that cover Part D prescription drugs as an optional supplemental benefit.

400

What is the deductible for Part D?

What is $400?

500

What are TWO LIS categories that will qualify you to have a Zero Dollar cost for your Pard D plan?

If a beneficiary has limited income and resources, he/she may qualify for the low-income subsidy (LIS) to cover all or part of the Part D plan premium and cost-sharing. In 2016, to qualify for the LIS:  Beneficiary income may not exceed 150% of the Federal Poverty Level (FPL). The 150% FPL varies geographically as follows: • 48 states - $17,820 (individual)/$24,030 (couple) in 2016. • Alaska - $22,260 (individual)/$30,030 (couple) in 2016. • Hawaii - $20,505 (individual)/$27,645 (couple) in 2016.  Beneficiaries resources may not exceed $13,640 (individual)/$27,250 (couple)

Medicare Select

100

What is Medicare Supplement Insurance (Medigap)?

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

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What is True or False: Is it illegal for an agent to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan?

True

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What do Medigap policies NOT cover??

Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing

400

What is the amount of time you have to change your mind and switch to a standard Medigap policy from a Medicare select policy?

What is 12 months?

500

What is True of False - You can't join a Medicare Prescription Drug Plan and have a Medigap policy with drug coverage

If you have a Medigap policy with prescription drug coverage, this means you chose not to join a Medicare drug plan. If your Medigap policy covers prescription drugs, you must tell your Medigap insurance company if you join a Medicare Prescription Drug Plan so it can remove the prescription drug coverage from your Medigap policy and adjust your premium. Once the drug coverage is removed, you can't get that coverage back even though you didn't change Medigap policies. Your Medigap carrier must send you a notice each year telling you if the prescription drug coverage in your Medigap policy is creditable. You should keep these notices in case you decide later to join a Medicare drug plan.

Long Term Care

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Long-term care is a range of services and support for your personal care needs. Most long-term care isn't medical care, but rather help with basic personal tasks of everyday life, sometimes called activities of daily living. Medicare doesn’t cover long-term care (also called custodial care), if that's the only care you need. Most nursing home care is custodial care. Get more information about nursing home care. What is Long-term care and what does it cover?

Long-term care is a range of services and support for your personal care needs. Most long-term care isn't medical care, but rather help with basic personal tasks of everyday life, sometimes called activities of daily living. Medicare doesn’t cover long-term care (also called custodial care), if that's the only care you need. Most nursing home care is custodial care. Get more information about nursing home care. Medicare does cover: Care in a long-term care hospital Skilled nursing care in a skilled nursing facility Eligible home health services Hospice & respite care

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What is Long-term care - Hospitals, and how often is it covered?

Medicare Part A (Hospital Insurance) covers care in a long-term care hospital (LTCH). LTCHs specialize in treating patients who may have more than one serious condition, but who may improve with time and care, and return home. Your costs in Original Medicare Generally, you won't pay more for care in a long-term care hospital than in an acute care hospital. Under Medicare, you're only responsible for one deductible for any benefit period. This applies whether you're in an acute care hospital or a long-term care hospital (LTCH). You don't have to pay a second deductible for your care in a LTCH if: You're transferred to a LTCH directly from an acute care hospital You're admitted to a LTCH within 60 days of being discharged from an inpatient hospital stay If you're admitted directly to the LTCH more than 60 days after any previous hospital stay, you pay the same deductibles and coinsurance as you would if you were being admitted to an acute care hospital. Note To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service. Note Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

300

What is Skilled nursing facility (SNF) care, and how is it covered?

Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time. Medicare-covered services include, but aren't limited to: - Semi-private room (a room you share with other patients) - Meals - Skilled nursing care - Physical and occupational therapy* - Speech-language pathology services* - Medical social services - Medications - Medical supplies and equipment used in the facility - Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF - Dietary counseling *Medicare covers these services if they're needed to meet your health goal. Note: Medicare covers swing bed services in certain hospitals and when the hospital or critical access hospital (CAH) has entered into a "swing-bed" agreement with the Department of Health and Human Services (HHS), under which the facility can "swing" its beds and provide either acute hospital or SNF-level care, as needed. When swing beds are used to furnish SNF-level care, the same coverage and cost-sharing rules apply as though the services were furnished in a SNF. If you're in a SNF but must be readmitted to the hospital, there's no guarantee that a bed will be available for you at the same SNF if you need more skilled care after your hospital stay. Ask the SNF if it will hold a bed for you if you must go back to the hospital. Also, ask if there's a cost to hold the bed for you.

400

What is the cost for hospice care?

Who's eligible? If you have Medicare Part A (Hospital Insurance) AND meet all of these conditions, you can get hospice care: Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less). You accept palliative care (for comfort) instead of care to cure your illness. You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions. Only your hospice doctor and your regular doctor (if you have one) - not a nurse practitioner that you’ve chosen to serve as your attending medical professional - can certify that you’re terminally ill and have a life expectancy of 6 months or less. Your costs in Original Medicare $0 for hospice care. You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you're at home. In the rare case your drug isn’t covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it's covered under Part D. You may need to pay 5% of the Medicare-approved amount for inpatient respite care. Medicare doesn't cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).

500

What is the cost of prescription drugs while is a nursing home, OR how are they covered?

If you're in a skilled nursing facility (SNF) getting Medicare-covered skilled nursing care, your prescriptions generally will be covered by Part A. Depending on what kind of coverage you have, Medicare may pay for your health care and prescription drugs while you're in a nursing home. You can get Medicare health care in 2 ways Original Medicare- Original Medicare doesn't pay for most nursing home care. Most nursing home care helps with activities of daily living. Medicare covers very limited and medically necessary skilled care or home health care if you need skilled care for an illness or injury and you meet certain conditions. Medicare Advantage Plans and other Medicare health plans If you have a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan, check with your plan to see if it covers nursing home care. Usually, plans don't help pay for this care unless the nursing home has a contract with the plan. Ask the health plan about nursing home coverage before you make any arrangements. If the nursing home has a contract with your health plan, ask the health plan if they check the home for quality of care.