Chapter 8. Social Insurance

1. Who is eligible for Medicare?

➡️ People age 65+,

disabled for 2+ years,

permanent kidney failure (ESRD).

2. What are the four parts of Medicare?

➡️ Part A (Hospital),

Part B (Medical),

Part C (Medicare Advantage),

Part D (Drugs).

3. How is Medicare Part A financed?

➡️ Through payroll taxes (FICA).

4. What does Medicare Part A cover?

➡️ Inpatient hospital care,

skilled nursing,

home health care,

hospice.

5. When is the Initial Enrollment Period for Part A?

➡️ 3 months before to 3 months after turning 65.

6. When is the General Enrollment Period for Medicare?

➡️ January 1 to March 31 each year.

7. When can someone use a Special Enrollment Period for Medicare?

➡️ Any time if still employed and covered by a group health plan.

8. Is Medicare Part B mandatory?

➡️ No, it's optional and requires a monthly premium.

9. What does Medicare Part B cover?

➡️ Doctor services,

outpatient care,

limited prescription drugs,

wellness visits.

10. How is Medicare Part B funded?

➡️ By monthly premiums from insureds and general federal revenue.

11. What is Medicare Part C also called?

➡️ Medicare Advantage.

12. What are requirements to enroll in Medicare Part C?

➡️ Must be enrolled in both Part A and Part B.

13. Who provides Medicare Part C plans?

➡️ Private HMOs or PPOs approved by Medicare.

14. What does Medicare Part D provide?

➡️ Prescription drug coverage.

15. Is Medicare Part D mandatory?

➡️ No, it's optional and provided by private companies.

16. When is an employer health plan the primary payor?

➡️ When a Medicare-eligible individual is still working and covered by the plan.

17. What is Medigap insurance?

➡️ Private Medicare Supplement policies that fill coverage gaps.

18. What does Medigap Plan A cover?

➡️ Core benefits like Part A coinsurance, hospice care, and 3 pints of blood.

19. How do Medigap Plans B-N differ from Plan A?

➡️ They offer core benefits plus additional coverage options.

20. What is Medicaid?

➡️ A federal and state program for those with insufficient income/resources.

21. Who funds Medicaid?

➡️ Jointly funded by the federal and state governments.

22. What does OASDI stand for?

➡️ Old Age, Survivors, and Disability Insurance.

23. What must someone meet to receive Social Security disability benefits?

➡️ Proper insured status, disability definition, and waiting period.

24. How many work credits are required to qualify for Social Security Disability?

➡️ 40 credits (4/year), with 20 earned in the last 10 years.

25. How long is the Social Security Disability waiting period?

5 Months