deductible
Amount you must pay before you begin receiving any benefits from your insurance company
TERM
Medicare
DEFINITION
A national health
... [Show More] insurance program in the United States, begun in 1965 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services.
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Medicare Advantage
Medicare plans other than the Original Medicare Plan
Medicaid
A federal and state assistance program that pays for health care services for people who cannot afford them.
Medicare requirements
-must be 65 or older, disabled, or have end-stage renal disease
-have to be under a licensed physician
-home care recipients must also be homebound and in need of skilled nursing or therapy services on an intermittent basis
Medigap
a private insurance policy that pays the difference between the medical charge and the amount that Medicare pays
Medigap Eligibility and Enrollment
Unlike Part C which 'disenrolls' an individual from Parts A and Part B, a Medigap plan works with Part A and Part B, requiring recipients to first enroll into the Original Medicare program and then supplement it with a Medigap plan. Individuals who are enrolled in Part C cannot also receive coverage from a Medigap plan and must re-enroll into Parts A and B in order to purchased a Medigap plan. All Medigap insurers are required to offer a one-time, 6-month enrollment period after turning age 65 for individuals who have already enrolled in Medicare Part B that guarantees an enrollee the right to purchase any part of a Medicare supplement insurance policy, regardless of his or her health status. Beyond the initial enrollment period, an insurer can require a paramedical exam or an attending physician's statement if needed to ensure the health of the enrollee.
End-stage renal disease
the final stage of chronic kidney disease
Medicare Coverage
Hospital services, some home health, hospice, religiously-associated facilities
If a beneficiary requests to discuss other products not originally documented on the SOA, must youdocument a second SOA for the additional product type before the appointment may continue?
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Part A coverage
Inpatient hospital care, skilled nursing facility care, home health care and hospice care
Medicare Part B
The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies.
Part C coverage
(medicare advantage) managed care alternative to original medicare. provided through commercial insurers
Part D of Medicare
Prescription drug coverage
Original Medicare
Medicare Parts A and B providing only hospital and medical coverage.
Employer Group Health Coverage
Employer Group Health Coverage
AHIP, MUnder Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary's stay. After day 60 the amount gradually increases until day 90. After 90 days he would pay the full amount of all costs.
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Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a non-participating provider.
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Incorrect: Beneficiaries are responsible for a single deductible amount for each benefit period, followed by a per day coinsurance amount through day 90. For day 91 and beyond, there is a charge for each "lifetime reserve day" up to 60 days over a beneficiary's lifetime. After this, he would be responsible for all costs.
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