Thats Donuts
The Donut Hole is a common name for this stage of Medicare D
What is the Coverage Gap
A supplemental plan pays for which Medicare Part expenses (A-J)
What is part A and B
The stage after the coverage gap
What is catastrophic coverage
When reaching catastrophic coverage, X% of prescription copays will change
What is 100%
What is the Medicare Part B out of pocket maximum
What is there is no out of pocket maximum
The stage before the "donut hole"
What is Initial Coverage
The name of the entity which is the only unbiased service who helps patients select Medicare Plans
What is the SHIP Office
This is the day that Medicare plan stages reset
What is 12/31
The % OOP for an infusion drug for a patient who has traditional Medicare
20%
In 2024, this is the maximum copay $ charged if you have LIS
What is $11.20
The name of CMS assistance and/or plan type that helps to pay the patient OOP through the donut hole (either provided by the government or an additional plan purchased by the patient).
What is LIS
Name one thing that is covered in each Part: A, B, C, D, E, F, G
Part
A- Inpatient care in hospitals, critical access hospitals, and skilled nursing facilities
B- Office visits, Infusion (Part B) drugs, Lab tests, Ambulances
C- A + B + D, sometimes includes dental care, vision, OTC
D- Prescription Drugs
E- MediGap (no longer available for new enrollees)
F- Supplemental
G- Supplemental - PartB deductible
This is the copay amount for patients in 2024 who reach catastrophic coverage.
What is $0
Name the Medicare parts that have a patient OOP max
C and D
This is the amount in 2024 that is estimated a patient would pay to get to catastrophic coverage
What is $3,300
If a patient has an advantage plan, they cannot have a ____.
What is a supplemental
The act that reformed catastrophic coverage from a %5 co-insurance to $0 this year
What is the Inflation Act
Certain groups are the exception to traditional OOP % and copays- name one
What is an EGWP (Employer Group Waiver Plan): Railroad workers, Indigenous/protected populations, disability, unions, teachers with pensions, employers who offer health plans with pensions
In 2025, this amount will be the annual limit for prescription drug costs covered under part C or D
What is $2000
In the donut hole for 2024, who pays and at what percent? Which payee's contribute towards the amount to catastrophic coverage?
What are
-Patients 25% (Contributes)
-Drug Manufacturers- 70% (Contributes)
-Medicare- 5% (Does not contribute)
The Part B deductible is dependent on the patient's income. What is the Part D deductible based on?
What is The Plan He/She chooses.
This is how you tell what stage a patient is in when you have a paid claim
What is in the Claim Response- Benefit Stage Count
In 2020, it is estimated that X number of Medicare enrollees did not receive LIS but were potentially eligible
What is the only Medicare part that sets a max OOP based on the plan and not based on CMS
What is Part C (Advantage plan)