Chapter 14 medicare

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Chapter 14 medicare

  1. 1. MEDA 163 Medical Insurance Forms Chapter 14 Medicare
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. Physician Fee Schedules • Medicare Physician Fee Schedule • Resource-Based Relative Value Scale (RBRVS)
  6. 6. Medigap Coverage • Medicare Supplementary Insurance (MSI) • Supplements Medicare benefits by paying for services that Medicare doesn’t cover • Offered by Commercial Health Insurance Companies
  7. 7. 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
  8. 8. 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
  9. 9. 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.

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