Medicare and Medicaid Overview

A set of flashcards covering key concepts related to Medicare and Medicaid, their structure, eligibility, and coverage details.

Medicare

A federal health program primarily for individuals aged 65 or older, with some exceptions for certain health conditions.

Centers for Medicare and Medicaid Services (CMS)

A federal agency that administers and oversees the Medicare program.

Eligible populations for Medicare

Individuals ages 65 or older, those receiving Social Security benefits for two years, individuals with end-stage renal disease (ESRD) or ALS.

Part A of Medicare

Hospital insurance that covers inpatient care, skilled nursing facility care, hospice care, and home health care.

Part B of Medicare

Medical insurance that covers doctor services, outpatient hospital services, and home health visits.

Part C of Medicare

Medicare Advantage, which expands original Medicare benefits through private health insurance organizations.

Part D of Medicare

Prescription drug coverage offered through private insurance plans that contract with Medicare.

Initial Enrollment Period

A seven-month period during which a person can first sign up for Medicare, covering three months before, the month of, and three months after their 65th birthday.

General Enrollment Period

A period from January 1 to March 31 each year for enrolling in Medicare Part A or B if the Initial Enrollment Period was missed.

Special Enrollment Period

A period for those still covered by a group health plan to sign up for Medicare Part B without penalty.

Medicare Part A coverage limit

Covers inpatient hospital care for up to 90 days each benefit period, with a maximum of 60 lifetime reserve days.

Long Term Care (LTC) Insurance

Policies that provide coverage for individuals needing assistance with daily activities for a minimum of twelve months.

Activities of Daily Living (ADLs)

Basic self-care tasks that include eating, bathing, dressing, continence, and transferring.

Medicaid

A federally and state-funded program that offers low-cost or free health coverage for individuals with limited income.

Payer of last resort

The principle that Medicaid only pays for services after all other insurance sources have paid.