PHRM 3750 EXAM 2 | ACE EVERY QUIZ | CONFIDENCE BACKED BY ACCURACY!

PHRM 3750 EXAM 2 | ACE EVERY QUIZ |
CONFIDENCE BACKED BY ACCURACY!
Birth of Medicare - Answer: 1957: Proposed health insurance for elderly

1965: Amendments to Social Security Act

Medicare implemented July 1, 1966



Part A - Answer: Hospital insurance

-traditionally a 2 part program
- pays for "institutional care" like hospice, nursing homes



Part A is estimated to go bankrupt in - Answer: 2030

(if we repeal the ACA, medicare will automatically run out of money because a lot of provisions
in ACA extended the life of medicare part A)



As more people qualify for medicare, - Answer: there are less workers working to support them.
America is aging too quickly



Part B = - Answer: Supplementary Medical Insurance (been around since it all started)



Part C = - Answer: Medicare advantage/allows people to use managed care for insurance (been
around since 1977)



Part D = - Answer: Prescription Drug Benefit (been around since 2006)


Total enrollment in Medicare = - Answer: 54 million



Eligibility criteria: - Answer: - worked at least 10 years in medicare-covered employment
- US citizen or permanent resident

1
APPHIA - Crafted with Care and Precision for Academic Excellence.

,- at least 65 years old



Part A Premium - Answer: - Elderly do not pay a premium if they are eligible for social security
or had Medicare-covered gov't employment

- other elderly can purchase part A for a monthly premium of $407 (if they qualify)

- disability people who get better and start working agin can buy Part A



People under 65 who qualify: - Answer: -End Stage Renal Disease patients requiring dialysis or
a kidney transplant will get medicare (no matter the age)

- if someone received Social Security disability benefits for at least 24 months, they will be
allowed to get medicare (exception: ALS pts automatically qualify)

-THESE PPL DON'T PAY PREMIUMS


Medicare population - Answer: mostly elderly (65+)

then disabled (under 65)

then ESRD



Part B premium - Answer: - everyone who wishes to be covered by Part B is charged a monthly
premium of ~$105 (voluntary)

- 92% of medicare Population is enrolled in part B

- for every month you don't sign up for Part B that you could have, they add 10%



Part B premium for higher income beneficiaries: - Answer: - several brackets put in place in
2007

- If income exceeds $85,000 for an individual or $170,000 for a married couple: monthly
premium= $150

If income exceeds $214,000 for an individual and $428,000 for married couple: monthly
premium = $335




2
APPHIA - Crafted with Care and Precision for Academic Excellence.

, Financing for Part A - Answer: payroll taxes from employees (1.45%) and employers (1.45%)

- 2013 --> increase for higher income individuals



Financing for Part B - Answer: general revenue of federal government
- beneficiary cost sharing



Medicare Administration - Answer: -federal program

- Centers for Medicare and Medicaid Services (CMS)

- private claims administrators (bills are sent to someone contracted by the gov't like Aetna)



Inpatient Hospital care is based on the concept of a (A) - Answer: "benefit period"

- begins when pt enters hospital
- ends when pt has not been in hospital/skilled nursing facility for 60 consecutive days

- 90 days per benefit period

- 60 day life time reserve



If you need more than 90 days, - Answer: you have a lifetime reserve of 60 days = 150 days total



every time you start a new benefit period, - Answer: you get a new 90 days. the 60 life time
reserve does not renew



Inpatient psychiatric care benefit period = - Answer: 190 days in lifetime, then you're done
because medicare was never meant for long term care



Patient pays another deductible when - Answer: 60 days have passed and a new benefit period
starts.
Does not pay another deductible if reenters the hospital before 60 days is up



3
APPHIA - Crafted with Care and Precision for Academic Excellence.