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Chapter 14 medicare

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Chapter 14 medicare Chapter 14 medicare Presentation Transcript

  • 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
  • Physician Fee Schedules
    Medicare Physician Fee Schedule
    Resource-Based Relative Value Scale (RBRVS)
  • 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.