6012 Exam 2 Test Questions Fully
Solved.
1.) Over 65 AND qualify for SS benefits (10 years or 40 quarters of earning; can be your own or
spouse's)
2.) Disability: must qualify for SS Disability Income (SSDI) and have been collecting such benefits
for at least 24 months
3.) Diagnosis of end-stage renal disease (ESRD), or Lou Gehrig's disease (ALS), AND receiving
SSDI payments (no waiting period) - Answer What are the 3 main pathways to Medicare
eligibility?
~60 million people with Medicare today
- the Baby Boomer generation are becoming eligible at a rate of ~10,000 per day and have been
for the last 10 years
- Baby Boomers are healthier than their parent's generation and living longer, so a greater share
of the U.S. is being enrolled in Medicare and staying on Medicare longer - Answer Describe
the state of Medicare enrollment today
1.) Part A: hospitals/inpatient services
2.) Part B: physicians/outpatient services
3.) Part C: managed care plans (also known as Medicare Advantage)
4.) Part D: prescription drug plans (*newest addition in 2003) - Answer What is the 4-part
structure of Medicare?
- mandatory enrollment without premiums (paid by the Hospital Trust Fund; funds taken from
income tax)
- benefits include inpatient hospital care AND skilled nursing facility (post-acute care and
hospice); *long-term care (i.e. nursing homes) are NOT covered
- cost sharing kicks in for hospital care after 60 days and for skilled nursing facility care after 20
days - Answer What are some key characteristics of Medicare Part A?
- voluntary enrollment (95% are enrolled)
- NOT funded by income tax; funded by general federal tax revenue instead
, - services covered: physician services, outpatient services (including durable medical
equipment), drug administration by physician (i.e. chemotherapy), specified preventive services,
and home health visits
* If you don't sign up for Part B when you're eligible, you'll end up owing more money
- for every year that you're eligible and don't enroll (and don't have any other coverage), there
is a 10% penalty added to all future months
- monthly premium ~$134 (in 2018); covers about 24% of Part B costs
* premiums are higher for higher incomes
- annual deductible ~$183 (in 2018) and cost sharting (usually 20%) - Answer What are some
key characteristics of Medicare Part B?
$1340 deductible for each benefit period
Days 1-60: $0 coinsurance for each benefit period
Days 61-90: $335 coinsurance per day of each benefit period
Days 91-beyond: $670 coinsurance per each "lifetime reserve day" after day 90 for each benefit
period
Beyond lifetime reserve days: all costs - Answer Medicare Part A Hospital/Inpatient
Deductible (What the beneficiary owes)
supplemental insurance coverage for out-of-pocket costs not covered by parts A and B of
Medicare
10 plan types available
- the C and F plans cover both the Part A and Part B deductible; over 50% of people with
Medigap choose Plan F
- employer-sponsored supplemental coverage plans exist, however they are less common
Medicaid can also be used as supplemental coverage
- Medicaid helps pay for Medicare's premiums and cost sharing for 20% of Medicare
beneficiaries with low incomes and modest assets (known as "dual eligibles") - Answer What
is Medigap?
- Prohibits Medicare supplemental insurance (Medigap) policies from covering the Part B
deductible for people who become eligible for Medicare on or after 01/01/2020
Solved.
1.) Over 65 AND qualify for SS benefits (10 years or 40 quarters of earning; can be your own or
spouse's)
2.) Disability: must qualify for SS Disability Income (SSDI) and have been collecting such benefits
for at least 24 months
3.) Diagnosis of end-stage renal disease (ESRD), or Lou Gehrig's disease (ALS), AND receiving
SSDI payments (no waiting period) - Answer What are the 3 main pathways to Medicare
eligibility?
~60 million people with Medicare today
- the Baby Boomer generation are becoming eligible at a rate of ~10,000 per day and have been
for the last 10 years
- Baby Boomers are healthier than their parent's generation and living longer, so a greater share
of the U.S. is being enrolled in Medicare and staying on Medicare longer - Answer Describe
the state of Medicare enrollment today
1.) Part A: hospitals/inpatient services
2.) Part B: physicians/outpatient services
3.) Part C: managed care plans (also known as Medicare Advantage)
4.) Part D: prescription drug plans (*newest addition in 2003) - Answer What is the 4-part
structure of Medicare?
- mandatory enrollment without premiums (paid by the Hospital Trust Fund; funds taken from
income tax)
- benefits include inpatient hospital care AND skilled nursing facility (post-acute care and
hospice); *long-term care (i.e. nursing homes) are NOT covered
- cost sharing kicks in for hospital care after 60 days and for skilled nursing facility care after 20
days - Answer What are some key characteristics of Medicare Part A?
- voluntary enrollment (95% are enrolled)
- NOT funded by income tax; funded by general federal tax revenue instead
, - services covered: physician services, outpatient services (including durable medical
equipment), drug administration by physician (i.e. chemotherapy), specified preventive services,
and home health visits
* If you don't sign up for Part B when you're eligible, you'll end up owing more money
- for every year that you're eligible and don't enroll (and don't have any other coverage), there
is a 10% penalty added to all future months
- monthly premium ~$134 (in 2018); covers about 24% of Part B costs
* premiums are higher for higher incomes
- annual deductible ~$183 (in 2018) and cost sharting (usually 20%) - Answer What are some
key characteristics of Medicare Part B?
$1340 deductible for each benefit period
Days 1-60: $0 coinsurance for each benefit period
Days 61-90: $335 coinsurance per day of each benefit period
Days 91-beyond: $670 coinsurance per each "lifetime reserve day" after day 90 for each benefit
period
Beyond lifetime reserve days: all costs - Answer Medicare Part A Hospital/Inpatient
Deductible (What the beneficiary owes)
supplemental insurance coverage for out-of-pocket costs not covered by parts A and B of
Medicare
10 plan types available
- the C and F plans cover both the Part A and Part B deductible; over 50% of people with
Medigap choose Plan F
- employer-sponsored supplemental coverage plans exist, however they are less common
Medicaid can also be used as supplemental coverage
- Medicaid helps pay for Medicare's premiums and cost sharing for 20% of Medicare
beneficiaries with low incomes and modest assets (known as "dual eligibles") - Answer What
is Medigap?
- Prohibits Medicare supplemental insurance (Medigap) policies from covering the Part B
deductible for people who become eligible for Medicare on or after 01/01/2020
