However, if a Medicare-eligible patient has an illness or injury not related to black lung, they may submit a claim to Medicare. They may receive coverage through Medicaid, Medicare, or both.Many Dual Eligible Beneficiaries choose to receive what?special coordinated care through a D-SNP, a special needs plan for duals.Dual eligible beneficiaries make up ______ of all Medicaid beneficiaries and _______ of all Medicare beneficiaries.Dual eligible beneficiaries take up _______ of all Medicaid spending and ______ of all Medicare spending Drugs used with an item of DME, including COPD medications given by a nebulizerUnder Medicare Part B, Medicare reimburses at what?What is Typically Not Paid for By Medicare Parts A & B?Custodial Long Term Care, Dental, Vision, Hearing and may be apart of what?these may be a part of a Medicare Part C plan's benefit packages as they are allowed to cover more than what Parts A & B allow.For Medicare Advantage, Medicare beneficiaries can enroll in what?a private health plan such as a HMO or PPO while receiving all Medicare-covered benefits - Part A, Part B, and (typically) Part DThe number of beneficiaries enrolling in Medicare Advantage has (increased or decreased)?is funded from the same sources as Medicare Parts A, B, and DMedicare Advantage plans vary in benefit design, which means what?means premiums, deductibles, copayments, coinsurance, formularies, and network differ widely depending on the "sponsoring" planMedicare also provides coordinated care coverage for patients with what special needs?Beneficiary lives in an institution (like a nursing home) or requires nursing care at home.Beneficiary has both Medicare and Medicaid coverageBeneficiary has one or more of the listed severe or disabling chronic conditionsWhat are the conditions that are considered for the Chronic Condition SNP (C-SNP)?SNPs currently are required to be reauthorized by who?Medicare Supplement Insurance Policies (Medigap Coverage) plans are provided by what?These plans are provided by private insurance companies and supplied supplemental coverage for 20% of beneficiaries in traditional Medicare (Parts A & B) in 2011.Medigap plans partially cover Medicare Parts A & B cost-sharing requirements, including what?The Skilled Nursing Facility care coinsurance is covered by which Medigap Plans?C, D, F, G, K (at 50%), L (at 75%), and M, N (at 100%)The Medicare Part A deductible is covered by which Medigap Plans?B, C, D, F, G, K, M (at 50%), L (at 75%), and N (at 100%)The Medicare Part B deductible is covered by which Medigap Plans?The Medicare Part B excess charges are covered by which Medigap Plans?Foreign travel emergency costs up to the plan's limits are covered by which Medigap Plans?out-of-pocket limits of $4,660 and $2,330 respectively in 2012.General revenues, beneficiary premiums, & state paymentsOutpatient prescription drugs through private plans (or sponsors) that contract with Medicare as part of both stand-alone prescription drug plans (PDPs) and Medicare Advantage drug plans (MA-PD)Medicare Part D premiums averaged _____________ per month during 2016.What are the Three Phases of a Part D Beneficiary's Coverage Calendar Year?Describe the Three Phases of a Part D Beneficiary's Coverage Calendar Year?Coverage may not begin until a deductible has been met.After the deductible phase, patients are subject to normal copayments and coinsurance amountsAfter leaving the coverage gap, patients are responsible for no more than 5% of drugAfter Medicare pays out a certain dollar amount to the patient, the patient is responsible for a percentage of all drug costs until another dollar threshold is metUnder 42 CFR §423.153(d), a Part D sponsor must establish an MTM program that what?1.) Technically, Medicare funding comes from the Medicare Trust Funds. Anyone who meets eligibility rules has a right to coverage and To receive federal funding, states must cover what certain "mandatory" populations for Medicaid?1.) Still Parts A & BA new type of coordinated benefit created in 1997. Instead of being about volume, it will be more focused on value, quality of care, and outcomes.Medicaid is a public insurance programs that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities.Is the Medicaid program run by the federal or state government?Though funded jointly by the federal government and the states, each state operates its own Medicaid program within federal guidelines.Why do states have a great deal of flexibility in designing and administering their Medicaid programs?Although the federal guidelines are broad for Medicaid, many states have yet to what?many states have yet to expand their Medicaid program as allowed under the Patient Protection and Affordable Care Act.Because the federal guidelines are broad, states have a great deal of flexibility in designing and administering their programs.
Created the Part D benefit.1.) Does the Medicare tax pay for the entire Medicare program? However, in 2012, the US Supreme Court held that states do not what?states do not have to expand Medicaid and all federal subsidies for Medicaid cannot be withheld from a state that chooses to not expand their Mcd program.19 states have not expanded Medicaid to additional persons. The Medicare Access & CHIP Reauthorization Act (MACRA) What did the The Medicare Access & CHIP Reauthorization Act (MACRA) create?the Quality Payment Program to bring quality and value to Medicare payments.Why is the Quality Payment Program important for pharmacists?Though pharmacists are not directly involved in the program, there may be potential tie-ins through primary care and specialized care models.What did to the creation of the Alternative Payment Models do?the federal government is changing the way we pay for care.