Medicare and Medicaid

Medicare ___ pays for care provided to pts in hospitals, skilled nursing facilities, hospices, and home healthcare programs

Part A

Medicare ___ provides coverage for physicians’ services and outpatient hospital care

Part B

Medicare ___ is also known as Medicare Advantage

Part C

Medicare ___ is also known as the Prescription Drug Benefit

Part D

To be eligible for Medicare Part A premium free based on age must:

• be age 65 or older

• have a specified number of quarters of coverage

• be eligible monthly social security or railroad retirement board cash benefit

• file an application for social security/railroad board benefits

Which of the following statements are true regarding Medicare Part B:

• eligible for Part A and pay a premium

• not required, but medicare enrolls have parts A and B

• social security premiums are deducted from social security checks

Medicare Part A: inpatient hospital care is based on a benefit period, ending 60 days after leaving inpatient treatment

true

Medicare Part A: SNF is limited to 100 days of SNF care per benefit period

true

Pt presents to ED for CHF exacerbation on October 1st and spent 1 day getting observation services. Then he was formally admitted to the hospital as an inpatient for 2 more days.

Does this meet the 3 day inpatient hospital stay requirement?

false

Covered services under Medicare part B include:

• most settings of physician services

• preventative services (vaccines, cancer/osteoporosis screening)

• outpt hospital service (x-rays, labs, PT, OT)

Medicaid is a joint state-federal program, states have flexibility to determine criteria within federal guidelines

true

Required services that are covered under Medicaid include:

• inpatient hospital services

• outpatient hospital services

• labs and x rays