PUBH 6012 Exam 3 Questions with Correct Answers
What is Medicare? - Answer-- Health insurance program for individuals over 65 years old and individuals with certain terminal illnesses
- Enacted under Lyndon B. Johnson in 1965 in the social security act
- Administered by the centers for medic...
PUBH 6012 Exam 3 Questions with Correct Answers What is Medicare? - Answer -- Health insurance program for individuals over 65 years old and individuals with certain terminal illnesses - Enacted under Lyndon B. Johnson in 1965 in the social security act - Administered by the centers for medicare and medicaid services (federal agency) - Broken into four parts, Part A, B, C, & D Eligibility requirements for Medicare (Entitlement to Part A and eligibility to enroll in parts B, C, and D) - Answer -- 65 y/o and qualify for social security benefits (10 years or 40 quarters or earning) - Must qualify for disability (SSDI) and have been collecting for 24 months - End stage renal disease (ESRD), Lou Gehrig's disease, ALS, and receiving SSDI payments no waiting period - Must be a U.S. citizen or permanent legal resident Explain the 4 part structure of Medicare - Answer -Part A: Hospitals/inpatient services (only part that is automatically given) Part B: Physicians/outpatient services Part C: Managed care plans Part D: Prescription drug plan Describe the coverage of Part A - Answer -Hospital Insurance - Inpatient hospital care - Days 1 -60: Deductible only - Days 61 -90: Coinsurance - Hospice care - No cost - Skilled Nursing facility - Days 1 -20: $0 - Days 21 -100: coinsurance - LONG TERM CARE NOT COVERED How is Part A funded? - Answer -Hospital insurance trust fund - Mandatory 2.9% payroll tax (covers 90% of Part A funding) - Employers pay 1.45% - Employees pay 1.45% if their income is up to $200,000 per individual or $250,000 per couple OR 2.35% if their income is over $200,000 per individual or $250,000 per couple - Other sources (covers 10% of Part A funding) - Taxation in social security benefits - Premiums for those ineligible on part A - Interest earned on hospital insurance trust fund Describe the coverage for Part B - Answer -Medical Insurance - Enrollment is voluntary - Cost sharing is 20% coinsurance after deductible is met - Coverage - Physician services (including in a hospital) - Outpatient services (including durable medical equipment) - Drugs administered by a physician (chemotherapy) - Specified preventative services (vaccines and cancer screenings) - Home health visits How is Part B funded? - Answer -- Supplemental medical insurance (SMI) fund is financed by - General federal tax revenue (covers 73% of Part B) - Monthly premiums (covers 24% of Part B) - $164.90/month premium - 10% penalty for each year eligible but not enrolled and tacked onto all future months - Copayments and coinsurance for payments rendered Part A vs. Part B vs. Part C - Answer -- Part A and B are known as traditional medicare (fee for service) - Part C aka Medicare Advantage is a managed care (capitated) plan - Part C enrollment is voluntary but restricted for those eligible for Part A and B - May enroll in either Part A and B OR in only part C (medicare advantage) Describe the coverage for Part C - Answer -- Plans must be actuarially equivalent to traditional FFS (fee for service) - Each plan must cover at least all covered in parts A and B - Limits out of pocket spending - Frequently offers additional benefits such as hearing, dental, and vision - Often restricts providers and requires prior authorizations for some services How is Part C funded? - Answer -- Hospital insurance trust fund (42%) - Supplemental medical insurance fund for parts B and D benefits - Medicare advantage cost sharing, deductibles, and premiums
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