Medicare

Medicare Basics

100

What are the two parts of Original Medicare?

Part A & Part B

200

What do Part A & Part B cover

Part A) Inpatient care (Acute hospital, Blood, SNF, Hospice, Home Health care)

Part B) Outpatient care (Outpatient surgery, Labs, DME, Doctors visits)

300

When was Medicare created and who administers Original Medicare 

1965 & CMS

400

1364

Part A deductible

500

Late enrollment penalty for Part B and how long do you pay it?

10% for every 12 months past eligibility. You pay as long as you're enrolled in Part B.

MA

100

What part of Medicare is a MA plan?

Part C

200

MAPD

Medicare Advantage with Prescription drug coverage

300

When is OEP?

January 1st-March 31st

400

MOOP

$6,700 in network and $10,000 out of network

500

HMO, PPO, PFFS, SNP

Health Maintenance Organization, Preferred Provider Organization, Private Fee For service, Special Needs Plan

Medigaps

100

Rating Method

Attained Age, Issue Age, Community Rated 

200

How much is the copay for doctors visits under Plan N?

Up to $20

300

Does Plan F cover your Part B Premium?

NO!!!

400

Issue Rights

Underwritten, Guaranteed Issue, Open Enrollment 

500

Three states standardized in different ways.

WI, MN, MA

Part D

100

Late Enrollment Penalty

1% for each month x national average premium. (2019 $33.19)

200

TROOP

True Out of Pocket ($5100)

300

Catastrophic Coinsurance/Copay

The greater of 5% or $3.40 (generic) and $8.50 (Brand name)

400

LIS

Low Income Subsidy

500

Phases of Part D

1) Deductible 2) Initial Coverage 3) Coverage Gap (Donut Hole) 4) Catastrophic Coverage