medicare lecture 1

• 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.