Medicare Part A – Flashcards

Helps cover inpatient care in hospitals Most people don't pay for it Starts 1st day of the month you turn age 65

Approximate Costs Hospital Stays

Semi Private room, $1260 deductible each benefit period Days 1 to 60: $0 co insurance Days 61-90: $315 per day Days 91+: $630/day

Pt. pays $0 for first 20 days Pt. pays $157.50 for days 21-100 Days 101 and beyond: all costs

Helps cover MD services and outpatient care Monthly premium = $104.90 Deductible = $147 annually (+ 20% of Medicare-approved amount for services after deductible) Person pays premium based on income

Diagnostic Tests Covers 2nd opinion for surgery Outpatient medical/surgical services Durable medical equipment (walker) Blood tests Preventative Services (FOB, Pap , PSA)

Prostate specific antigen

Ambulance (if medically necessary) Diabetic Supplies (not syringes/insulin) Foot exams (if are diabetic) Kidney Long-term care is NOT covered Medications are NOT covered Blood transfusions

Prescription drug plan Medicare Part D Generally will pay a monthly premium Not all drugs are covered by all plans

Not all drugs are covered by all plans

Deductible = $310 After deductible is met, beneficiary pays 25% of costs Initial costs must reach $3310 in 2016 The Donut hole -beneficiary pays 45% of price of generic drugs (in 2015) Then pays lesser amount for drugs after has paid $4700 Premium depends on plan (often less than $40/month)

Premium: 28.80/month Deductible: $320 Co-Pay: 25% of costs 'Out of Pocket Limit: $6700

CIGNA Medicare Rx Plan Three Monthly premium = 32.90 Annual deductible = $325 Amount for prescription = $2-$68 co-pay

Certain physical and/or mental impairments trigger benefits. Generally R/T inability to perform certain ADLs, Typically, benefits are payable when you're unable to perform a certain number of ADLs (e.g., two or three).

By 2020 12 million older adults will need Long term care Family/friends are caregivers for 70% of elders People age 65 have a 40% lifetime risk of entering a nursing home 10% will stay there 5 years or longer 22% of > age 85 are in a nursing home One year in a nursing home averages > $50,000

Based on how much coverage a person wants Benefit period (# of years) Maximum lifetime benefit Example: Person age 65 pays approximately $2500/year with $150/day benefit for 4 years

Benefit Triggers Often when can't do 2-3 Bathing (be sure this is included) Toileting Eating Dressing Walking

Alzheimer's Disease (may be physically capable, but not cognitively) Coverage Exclusions? Pre-existing conditions? Drug/alcohol abuse Mental disorders Self-inflicted injuries Alzheimers Heart disease Diabetes Cancer

Die without using benefits? Rate increases? May be up to 20%