medicare lecture 1

Cards (24)

  • eligibility
    if US citizen OR have been a legal resident for >5 years AND:
    • 65+ years of age
    • permanently disabled
    • end stage renal disease
    • amyotrophic lateral sclerosis (ALS)
    • exposed to environmental health hazards
  • medicare card
    • typically mailed 3 months before beneficiary turns 65
    • benefits only become effective the 1st day of the month they turn 65
    • those not automatically enrolled can sign up for medicare during 7 month window
  • if you sign up before the month you turn 65
    coverage starts the month you turn 65
  • if you sign up the month you turn 65, or during the 3 months after
    coverage starts the next month
  • permanent disability

    medicare usually begins 30th month after disability begins
    • congenital disorders
    • blind
    • deaf
    • injuries (traumatic brain, spinal cord, para or quadriplegic)
  • permanent kidney failure requiring either dialysis or a kidney transplant ESRD
    • coverage begins the first day of the 4th month of dialysis treatment
    • coverage begins the month you're admitted to get a kidney transplant if your transplant takes place in that same month or within the next 2 months
    medicare coverage may END
    if you're eligible for medicare only because of ESRD, your coverage will end
    • 12 months after the month you stop dialysis treatments OR
    • 36 months after the month you have a kidney transplant
  • ALS
    • neurodegenerative disease
    • 5 years life expectancy
    • die from respiratory issue
    • 5 months waiting for medicare coverage
  • what medicare does not cover
    • cosmetic surgery
    • massage therapy
    • hearing aids and exams
    • most dental care, dentures
    • eyeglasses, eye exams - diabetes, you can get a yearly exam for retinopathy
    • or if you have glaucoma it is covered
    • longterm care at home or in a nursing home, when the care you need is assistance with daily living
  • medicare part a
    • inpatient care in hospital
    • skilled nursing facilities (not long term or custodial care)
    • home health
    • hospice
  • medicare part b
    • medical insurance
    • outpatient medical coverage
    • physician visits
    • DME
    • preventative services
  • medicare part c
    • medicare advantage
  • medicare part d
    • prescription drug coverage
  • skilled nursing facilities
    • 3 day minimum
    • daily help required (IV fluids/meds, physical therapy)
  • home health
    • must be homebound
    • medically necessary skilled care
    • infusion services
    • nursing visits
    • PT
    • leaving home isn't recommended
    • trouble leaving home without help
  • hospice
    • comfort care (palliative care)
    • no wish to cure terminal illness
    • two doctors must certify that you are terminally ill and under 6 months to live
    • symptom control and pain relief
    • DME
    • medical/nursing/social services
    • counseling
    • copay for drugs under $5
  • doctor services
    part b
    • welcome to medicare
    • annual wellness visit (health risk assessment)
    • routine visits
  • outpatient care
    part b
    • ambulance
    • dialysis
    • ER
    • mental health
    • opioid use treatment
    • labs
    • diagnostics
    • drugs - limited
  • DME
    part b
    • insulin - infusion pumps
    • lancets
    • test strips
    • syringes billed to medicare part D
    • blood glucose monitors
    • nebulizers
    • oxygen
    • wheelchairs and scooters
    • walkers and canes
  • vaccinations billed to part b

    flu
    pneumococcal
    hep b (medium/high risk)
    covid
  • preventative services
    • part b
    • bone mineral density
    • cv
    • depression
    • diabetes (including dpp)
    • smoking cessation
  • hep b risk categories
    • intermediate risk groups
    • high risk
  • intermediate risk
    • staff in institution for the developmentally disabled
    • workers in health care profession who have frequent contact with blood/bodily fluids
  • high risk
    • ESRD
    • hemophilia
    • clients of institutions for the disabled
    • same household as HBV carrier
    • homosexual men
    • illicit injectable drug abusers
    • diabetes
  • Your Hepatitis B risk increases if one or more of these conditions applies to you:
    • You have hemophilia and you get factors VIII or IX.
    • You have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).
    • You have diabetes.
    • You live with someone who has Hepatitis B.
    • You're a health care worker and have frequent contact with blood or bodily fluids.