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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.