Summary Medicare training Study Guide

Medicare training Study Guide Medicare program basics - -Medicare is a health benefit program for U.S. citizens or permanent residents who meet certain work history requirements. -Medicare is administered by the Centers for Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services Medicare Law--Title XVIII of the Social Security Act - Health insurance for the aged and disabled Total XVIII is split into several subsections Part A-Hospital Part B-Medical Part C-Medicare health plans, which must cover Part A and Part B benefits Part D-Prescription drug coverage Overview of different ways to get Medicare - -Original Medicare A & B -Medicare Advantage Plans (Medicare Part C with or without Part D) -Medicare Prescription Drug Plans -Original Medicare + Medigap -Medicare cost plans or Pace Plans Overview of different ways to get Medicare con't. - -Original Medicare Part A--Hospital, skilled nursing facility, hospice, and home health services Part B--Professional services such as those provided by a doctor or non-physician professional, outpatient care, and other medical services Overview of different ways to get Medicare con't. - Part C--Medicare Health Plans (Medicare advantage plans must include Part A & Part B) --HMO (some also include Part D) --PPO's (some also include Part D) --Private Fee for Service plans PFFS (some also include Part D) Special needs plans (SNPs) ALWAYS include Part D --Medical Savings Account plan (do NOT include Part D) --Employer or Union group plans Overview of different ways to get Medicare con't. - Other types of Medicare Health Plans: --Medicare cost plans (some include Part D) --PACE plans INCLUDES Part D --Medicare-Medicaid plans (INCLUDES Part D) Part D- Prescription drug coverage --stand-alone PDP --coverage in a Medicare health plan Part C Medicare health plans - ALL Medicare advantage (MA) plans must: -cover all part A and part B benefits -provide plan cost-sharing actuarially equivalent to cost sharing under Medicare Parts A and B, but may be different for specific services and; -include an annual maximum out of pocket (MOOP) limit on total enrollee cost sharing (deductibles, coinsurance, and copayments) for Part A and B services Extra benefits-Medicare health plans also may cover extra benefits not covered by Original Medicare, such as: Part C Medicare health plans con't. - -lower cost sharing [NOTE: some plans reduce the Part B premium] -vision services -hearing aids -routine dental services and/or dentures -routine transportation to medical appointments -chiropractic services Medigap (Medicare supplement insurance - Medigap insurance -sold by private insurance companies to fill "gaps" in original Medicare coverage -works only with original Medicare -Covers all, or a portion of Part A and Part B cost sharing (coinsurance, copayments, or deductibles) for beneficiaries in original Medicare --Does NOT cover Medicare benefits, but works in tandem with original Medicare coverage. Some Medigap policies cover benefits not covered by Part A or B of original Medicare, such as extra days of coverage for inpatient hospital care or foreign travel emergency care.