Medicare Part A
$1,364
What is the deductible for a hospital stay for days 1-60?
$185.00
What is the Annual deductible for 2019?
Seven month period:
3 months before a person turns 65, the month that they turn 65 and 3 months afterwards. Or 3 months before the 25th month of certified disability the month of and 3 months afterwards.
What is the Initial Enrollment Period?
$415
What is the part d annual max deductible?
Does not count towards the 3 day inpatient stay.
What is observation Status or outpatient days?
91-150
What are Lifetime Reserve Days?
$135.50
What is the Standard monthly Premium?
October 15- December 7th
What is the Annual Election Period (or as we like to call it Open Enrollment)?
List of prescription drugs covered by the plan
What is the plan formulary?
A person may have to pay for the first 3 under part A if from a hospital. If under part B, pay for the first 3 and then 20%. Unless they or some one else donates on their behalf.
What is Medicare Blood coverage?
Only part of medicare that covers Spiritual Care and Support for both Patient and Family
What is Medicare Hospice coverage?
-To be able to withstand repeated use.
-Primarily used for a medical purpose & is useful during illness or injury.
-Appropriate for home use
What is Part B Durable Medical Equipment Coverage?
January 1- March 31st.
What is the General Enrollment Period?
The plan requires the beneficiary to try a different or less expensive drug first.
What is step therapy?
An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the Medicare‐approved amount as full payment for covered services, and not to bill you for any more than the Medicare deductible and coinsurance.
What is Medicare Assignment?
Not received skilled care for 60+ days.
What is a new inpatient hospital benefit period?
The difference between what medicare pays and the amount charged. (In MN only DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS AND SUPPLIES (DMEPOS) are able to)
What is the medicare part b excess?
Up to eight months after employment or employer group health plan coverage ends, whichever is first.
Employer group health plan coverage must be based on your, or your spouses's current employment (Cobra or retiree coverage does not qualify)
What is Medicare A and B special enrollment period?
Happens when you and the plan reach around $3,820
What is the donut hole or coverage gap?
If you or your spouse are currently working but want to enroll into Medicare A and Medicare B, you must stop contributions.
What is an HSA (health savings account)?
$240 and $437
What is the part A Premium for voluntary enrollees?
(With 30-39 quarters of Social Security coverage: $240 per month, With 29 or fewer quarters of Social Security coverage: $437 per month )
•Full-time care at home
•Prescription drugs
•Meals delivered to the home
•Homemaker services such as cleaning, washing dishes/clothes, and shopping
•Custodial care (such as bathing), unless these services are performed along with medically necessary services
What are the things medicare home health will not pay for?
Some examples would be:
- You move out of your plan's service area
-The plan is no longer available
-You live in, moved out of or into a skilled nursing facility
What is a special enrollment period for medicare advantage or part d plans?
Expenses that count toward total out-of-pocket
True Out-of-Pocket Costs (TrOOP)
If a service is not covered by Medicare, or is questionable for coverage, the provider must issue this.
What is an ABN (Advanced Beneficiary Notice)?