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41 Terms
What is medicare
a federal insurance program that is for those 65+ disabled, or have certain diseases
How can spouses be eligible for medicare?
benificiary of spouse who paid into it for 10 years
what is a dual eligible
eligble for medicaid and medicare
What is medicare pt A
covers inpatient hospital stay, SNF, home and hospice carew
what is medicare part b
covers outpatient care, xrays labs, PT and OT, drugs that doctor administers adn DME
What is medicare part C
medicare advantage plan combining A and B into one
What is medicare part D?
medicare prescription drugs plan
Why are medicare spendigns going up
people are living longer
How to get enrolled in medicare?
Verify eligibility through social security
Enrollment for medicare part A?
automatic at 65
enrollment for medicare part B?
have to pay a preminum, not required to take
enrollement for medicare part C and D?
must sign up
which parts of medicare have limited enrollment
B and D
What is secondary insurance?
helps to cover the 20% that medicare doessnt cover
what is a group health plan
secondary insurance that is from a former employer that supplemtns medicare
what is medicare supplemental insurance?
secondary private insurance that coordinates with original medicare known as medigab
How can medicaid act alongside medicare?
as a secondary insurance
A la cart medicare
parts a and B, secondary insurance, and RX coverage
Medicare part C makeup
managed care options like HMO and PPO or non managed care like private FFS or medicare savings account
What are medicare advantage plans
have a premium and limited provider networks with lower cost sharing while covering dental vision and hearing services
When did medicare part D come into play
January 1 2006
How did medicare part D come to be?
apart of the MMA act of 2003
What did medicare part D help with
voluntary outpatient prescription drug coverage, not a benefit, no OTCS covered
How does medicare part D cover?
medicare contracts with private insurance to provide benefits
How many firms in control of part D?
5
Who pays for medicare part D?
federal govt, enrollees, and state
What is low income subsidy
known as extra help, helps patients with lower incomes afford their meds
When can you enroll for part D?
65 + or - 3 months
How much are you charged for every month youre late for medicare?
1%
What is credible coverage?
keeping coverage from employeer if still working
How can you avoid part D penalty
LIS
what is enahnced benifit in part D?
cheaper deductibles, premiums, payments etc
What is standard benifit in medicare part D?
pay premium and have to pay deductible will then pay 25% coinsurance until you reach catastrophic coverage
cost saving tools under part D
step therapy
prior authorization
quantity limits
tiered formualaries
What medications arent covered under medicare part D?
cosmetics, OTC, minerals and vitamins, smoking cesation
Is part D forced?
no it is voluntary
Is part D run by federal govt?
no it is independent companies approved by medicare
When can enrollees change plans for medicare part D?
october 15th-december 7th
When can a patient use their new medicare part D plan
January 1
What is MTM eligibility?
3 or more core chronic conditions, 2-8 covered part D meds, spending at least 1,276 for their drugs
what are some chronic conditions
HIC, mental health, COPD, hypertension, diabetes etc