Understanding Medicare Payment Systems, Exams of Nursing

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Medicare Payment

Systems- Part 2

EXAM

What must be met to qualify for Medicare - answer ✅✅65 or older, qualifying disability, End stage renal disease What happens if you don't sign up for Medicare on time - answer ✅✅Penalty is applied Which government body sets laws for Medicare - answer ✅✅Congress- sets conversion factor Who advises congress about Medicare policies - answer ✅✅MEDPAC

Who administers Medicare - answer ✅✅CMS original Medicare - answer ✅✅Part A and Part B; can add supplemental coverage and Part D What does part A Medicare cover - answer ✅✅Inpatient hospital care, Skilled nursing facility care, home healthcare, hospice Does Medicare part A have a premium - answer ✅✅No What is a benefit period for Medicare A - answer ✅✅Begins the day of admission as an inpatient and ends 60 days after receiving no inpatient care Is there a limit to benefit periods - answer ✅✅No What is part B Medicare - answer ✅✅Outpatient services- medically necessary Does Medicare B have a deductible and premium - answer ✅✅Yes What is the coinsurance for Medicare B - answer ✅✅80/20 with no out of pocket maximum What are Medicare supplements - answer ✅✅Optional extra insurance from private insurance companies

What is Part D Medicare - answer ✅✅prescription drug coverage (generic and brand name) What is Medicare advantage - answer ✅✅Alternative to original Medicare that blends part A, part B, and part D Does Medicare advantage have a provider network - answer ✅✅Yes- availability varies by county Is there a yearly limit for out of pocket costs on Medicare advantage

• answer ✅✅Yes Can you get supplemental coverage on Medicare advantage - answer ✅✅No Do you need referral for original Medicare and Medicare advantage - answer ✅✅Original- No Advantage- Yes When do you pay daily coinsurance for Part a - answer ✅✅Days 61- 90 of benefit period What funds Medicare part B - answer ✅✅SMI (supplemental Medicare Insurance trust fund), Beneficiary cost-share, Premium adjusted by income Medicare part B premiums - answer ✅✅increase with higher income

Medicare C- Medicare advantage goals - answer ✅✅Expand beneficiaries' choices to offer more coordinate care and comprehensive benefits Take advantage of efficiencies of private insurance Why do Medicare advantage plans cost more - answer ✅✅Government pays a set rate per person under a "risk-based contract" and the adjustments/bonus payments added to the set rate have increased the costs Medicare advantage- private insurers - answer ✅✅Can charge out of pocket costs and establish rules for service, which decreases the level of choice Can you switch from Medicare advantage to original Medicare - answer ✅✅Within the first 12 months of joining a Medicare advantage plan you can switch to original medicare