Medicare Basics
Medicare is defined as...
What is federal government health insurance for an individual?
Who is eligible to enroll in Medicare Part D?
What is:
Individuals that are _____?
All US Citizens, legal or permanent residents that have lived at least 5yrs prior to qualifying
Individuals with ESRD/ALS
Individuals less than 65yo and determined disabled
A Medicare beneficiary will have to pay a % of these costs when picking up their medication...
What is their coinsurance or copayment.
One contributing factor to reduce drug costs is to check to see if your medication is on this...
What is the plan's drug formulary.
SMP stands for...
What is the Senior Medicare Patrol.
Medicare is made up of these 4 parts:
Part A - HHH
Part B - MD, DME, Shots
Part C - ABD
Part D - ???
What is prescription drug coverage.
The federal government provides Medicare Parts A & B. Part D is provided by these...
What is private insurance companies.
The maximum deductible amount allowed for Medicare beneficiaries in 2020 is...
What is $435.
One of the many ways that a beneficiary can get Medicare counseling advice is to check the back of their Medicare & You handbook for their local assistance program known as this in Florida...
What is SHINE. Serving Health Insurance Needs of Elders
When someone steals or uses your personal information (like your name, Social Security number, or Medicare number), to submit fraudulent claims to Medicare and other health insurers without your authorization.
What is Medical identity theft.
Enacted as part of the Medicare Prescription Drug, Improvement & Modernization Act in 2003, Part D went into effect when?
What is January 1, 2006!
There are two types of prescription drug coverage available to enroll in...
What is:
PDP - stand-alone-rx plan
MAPD - medicare advantage plan
The period in which the insurance plan does not pay and the beneficiary must pay more for the cost of their drugs...
What is the donut hole or gap.
The financial assistance program offered by the Federal Government to reduce prescription plan costs is known as...
LIS - Low Income Subsidy or Extra Help
Knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to obtain a Federal health care payment for which no entitlement would otherwise exist
What is Medicare Fraud.
Either sold as generic or brand named; approved by FDA and sold in the US, a Medicare Beneficiary must have this to obtain.
What is a prescription
Prescription drug plan enrollments occur three different times.
This enrollment period happens annually at the same time each year...
What is October 15 - December 7.
When comparing your RX plan options, it is always good to check to see if your favorite pharmacy has contracted with the plan. If they are, they will be considered this...
What is a Preferred Provider.
Some people will qualify for the MSP financial assistance program that helps pay Part AB premiums, coinsurance, deductibles and penalties. The program is funded by...
What is the State of Florida.
Any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.
What is abuse.
Are chemotherapy drugs, weight loss, fertility and prescription vitamins covered under Part D insurance?
What is "No."
Part B pays for chemotherapy drugs and most other items are sold OTC.
A Medicare beneficiary who qualifies for LIS can make changes to their prescription drug plan...
What is once a quarter.
If you go without creditable RX coverage for more than 63 days upon Medicare eligibility, you will incur...
What is a lifetime penalty.
Calculated by national base amount (2020 = $.33) and multiplied by every month without creditable coverage.
These entities can assist when you are a victim of fraud.
SHINE CMS OIG SMP
One of these has been at the forefront of the Nation's efforts to fight waste, fraud and abuse in Medicare!
What is OIG. Office of Inspector General.