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# BAS Medicare
# BAS Medicare Terms
| Question | Answer |
|---|---|
| Medicare | Comprehensive Federal Insurance Program |
| Medicare is intended as financial assistance for only 65 and older. | False. Certain disabilites qualify for Medicare |
| ESRD stands for: | End Stage Renal Disease |
| Kidney Disorders that require transplant or dialysis qualify for medicare | TRUE |
| Medicare is administered by | The Center for Medicare and Medicaid Services. |
| HCFA is the older acronym for CMS | TRUE |
| CMS is a division of DHHS | TRUE |
| DHHS staNDS FOR | Department of Health and Human Services |
| Medicare is enacted by laws established by Congress | TRUE |
| Medicare A requires no premiums | TRUE |
| Medicare programs are funded by: | * Premiums * Deductibles * Coinsurance |
| Medicare Part A is insurance for: | Hospital insurance |
| Medicare part B is insurance for: | Medical Services at clinics, outpatient clinics, doctor offices |
| Medicare Part C is insurance for: | Medical services through a managed care plan. |
| Medicare Part D is insurance for: | Prescription Drugs |
| You are a patient in a SNF facility. This would be covered by: | Medicare Part A |
| SNF is | Skilled Nursing Facility Rehabilitation for individuals who have the potential to function independently after a limited period of care. A multidisciplinary team guides health care and rehabilitative services, including skilled nursing care. |
| Medicare Part A covers: | Inpatient Hospital Care Inpatient Care in a SNF Home Healthcare Hospice Care |
| Medicare reimbursement requires: | The medical service must be medically necessary |
| Medically Necessary means: | The medical service is reasonable. The service is necessary for Dx or Tx The service is necessary to improve functioning of a body part. |
| To be eligible for medicare part A: | Eligible for: social security benefits Based on wage deduction if Medicare is withheld |
| If you do not qualify for Medicare part A you cannot receive it. | FALSE: You can still get it but you need to pay a premium |
| Medicare Part B requires payment of a premium. | TRUE |
| Medicare Part B helps pay for: | Doctor Services Outpatient Hospital expenses DME (if reusable and if used in the home) |
| The Part B premium can be deducted from the person's social security check. | TRUE. |
| When should a person enroll in Medicare | A few month before the age of 65 |
| A person that does not sign up for Medicare B at the time they enroll in Medicare A will... | 1. Have premiums increased for each 12 months that they don't enroll. 2. Have no penalties if they are working and have a health insurance plan. |
| Medicare Part B has an annual deductible | TRUE |
| Medicare Part B pays: | 80% of allowable charges after the deductible is paid. |
| Medicare Part C is also called: | Medicare Advantage (MA) plan. |
| Medicare Part C plans can include: | PPOs PSOs PFFS |
| Medicare Part C includes both Part A and Part B coverage and additional services like: | Preventive Care Prescription Drugs Eyeglasses Dental Care Hearing Aids |
| Medicare Part D covers prescription drugs | TRUE |
| Premiums for Medicare Part D are deducted from the social security check | TRUE |
| There is an initial deductible of $250 for medicare part D | TRUE |
| Medicare part D pays for | 75% of all amounts over $250 and up to $2000 total. |
| Medicare Part D has a gap in coverage beyond $2250 for the next $3600. This is called the: | Donut Hole |
Created by:
rjmtoss
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