MEDA 163 Medical Insurance Forms Chapter 14 Medicare
Medicare Eligibility Individuals or spouses worked at least 10 years in Medicare-covered employment Individual’s minimum age 65 Citizen or permanent resident of US Can qualify if younger than 65 & have disability or ESRD
Medicare Benefits Medicare Part A Inpatient hospital critical care Skilled nursing facility stays Hospice care Some home health care Medicare Part B Doctor’s services Outpatient hospital care Durable medical equipment Some medical services not covered by Part A
Medicare Enrollment Automatically covered in Part A if individual or spouse had Medicare taxes taken in last 10 years with no premiums due Depending on length of time worked with Medicare taxes, premiums are $461 or $254/mo. Medicare Part B monthly premiums based on annual income Deductible of $155.00 annually
Medigap Coverage Medicare Supplementary Insurance (MSI) Supplements Medicare benefits by paying for services that Medicare doesn’t cover Offered by Commercial Health Insurance Companies
Advance Beneficiary Notice (ABN) Written document provided to Medicare beneficiaries prior to service being rendered that indicates the service is not likely to be a covered service and unpaid by Medicare
Primary or Secondary Payer? Primary Payer Employee eligible for group plan but declined or dropped coverage Also covered by TRICARE Under 65, disabled, ESRD or has been eligible for Medicare for more than 30 months Has both Medicare and Medicaid coverage Secondary Payer Employee participates in group health plan Third-party liability policy Worker’s Compensation coverage VA preauthorized services Federal Black Lung program
Medicare Websites Centers for Medicare and Medicaid Coverage Medicare Regional Administrative Service Medicare.gov Website assignment: Use the website www.medicare.gov to obtain the following information: List and briefly describe preventive services that are covered by Medicare. Due Tuesday Nov. 16.