CSS Medicare & Medicaid Benefits Flashcards

What is a 'Medigap' or Medicare Supplement policy?

Answer: Private insurance that covers gaps in Original Medicare like deductibles and copays

Medigap policies are sold by private insurers to help pay costs not covered by Original Medicare, such as deductibles, coinsurance, and copayments.

The Medicare Part B late enrollment penalty applies when a beneficiary:

Answer: Delays enrollment without qualifying creditable coverage

Beneficiaries who don't enroll in Part B when first eligible and lack qualifying creditable coverage face a 10% premium penalty for each 12-month period they delayed.

What does 'dual eligible' mean in the context of Medicare and Medicaid?

Answer: Qualifying for both Medicare and Medicaid simultaneously

Dual eligibles are individuals who qualify for both Medicare and Medicaid, with Medicaid often covering Medicare cost-sharing and additional services.

What is the Medicare Extra Help (Low Income Subsidy) program?

Answer: Federal assistance that helps low-income beneficiaries pay Part D premiums and drug costs

Extra Help (LIS) is a federal program that assists low-income Medicare beneficiaries with Part D premium, deductible, and co-payment costs.

Under Medicare hospice benefit, which of the following is TRUE?

Answer: Patients certify a terminal prognosis of 6 months or less and focus care on comfort

To elect the Medicare hospice benefit, a physician must certify that the patient is terminally ill with a life expectancy of six months or less if the disease follows its normal course.

What is Medicaid 'look-back period' and how long is it for nursing home applicants?

Answer: A 60-month (5-year) review of asset transfers before application

Medicaid's 60-month look-back period reviews asset transfers made in the five years prior to a nursing home application, penalizing gifts that could have delayed eligibility.