Practice Management Book

Medicare

  • Medicare

http://www.fpnotebook.com/

Medicare

Aka: Medicare, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D
  1. Types: Medicare Part A
    1. Funded by social security, taxes, hospital insurance
    2. Covers hospital care, home care and Hospice
    3. Reimbursement via Medicare intermediaries
      1. Payments based on per episode per diagnosis
  2. Types: Medicare Part B
    1. Funding
      1. Participants pay 25% of costs (~$50 per month)
      2. General taxes pay 75% of costs
      3. Medicare Supplemental Trust Fund
    2. Covers
      1. Clinician visits, PT and OT, Mental Health
      2. Lab, XRay, Durable medical equipment
    3. Reimbursement
      1. Deductible: $100
      2. Co-Payment: 20%
  3. Types: Medicare Part C
    1. Medicare Choice Plan
    2. Benificiary may choose private pay, medical savings accounts, or managed care
  4. Types: Medicare Part D
    1. Prescription Drug benefit
  5. Resources
    1. EDispense Vaccine Manager for Medicare Part D Vaccine Reimbursement
      1. https://enroll.edispense.com/ws_enroll/
  6. References
    1. Dial (2003) AAFP Board Review Lecture, Seattle

Medicare (C0018717)

Definition (NCI) The US federal health insurance program run by the Health Care Financing Administration for people 65 years of age or older, certain people with disabilities who have not reached this age, and individuals with permanent kidney failure with dialysis or a transplant. People over 65 years old, younger disabled people, and dialysis patients are eligible for the program regardless of their income. Participating beneficiaries pay part of healthcare costs through deductible amounts. Limited monthly premiums are required from beneficiaries for non-hospital coverage.
Definition (MEDLINEPLUS)

Medicare is the U.S. government's health insurance program for people age 65 or older. Certain people under age 65 can qualify for Medicare, too, including those with disabilities, permanent kidney failure or amyotrophic lateral sclerosis.

Medicare helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. The program has four parts:

  • Part A is hospital insurance.
  • Part B helps pay for medical services that Part A doesn't cover.
  • Part C is called Medicare Advantage. If you have Parts A and B, you can choose this option to receive all of your health care through a provider organization, like an HMO.
  • Part D is prescription drug coverage. It helps pay for some medicines.
Definition (NCI) A U.S. federal health insurance program for people aged 65 years or older and people with certain disabilities. Medicare pays for hospital stays, medical services, and some prescription drugs but people who receive Medicare must pay part of their healthcare costs.
Definition (MSH) Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)
Definition (PSY) Government health care program for the aged administered through the Social Security Administration or the US Health Care Financing Administration. Compare MEDICAID.
Concepts Regulation or Law (T089)
MSH D006278
HL7 MM
English Health Insurance for Aged and Disabled, Title 18, Health Insurance for Aged, Disabled, Title 18, Health Insurance for Aged, Title 18, HEALTH INSURANCE AGED DISABLED, HEALTH INSURANCE AGED DISABLED TITLE 18, HEALTH INSURANCE AGED TITLE 18, Medicare Program, medicare, Medicare
Swedish Medicare
Czech nemocenské pojištění pro staré a invalidy, oddíl 18
Finnish Medicare
Russian STRAKHOVANIE ZDOROV'IA PRESTARELYKH I NETRUDOSPOSOBNYKH, ZDOROV'IA STRAKHOVANIE PRESTARELYKH I NETRUDOSPOSOBNYKH (RAZDEL 18 ZAKONA SOTSSTRAKHOVANIIA SSHA), MEDIKEIR, ЗДОРОВЬЯ СТРАХОВАНИЕ ПРЕСТАРЕЛЫХ И НЕТРУДОСПОСОБНЫХ (РАЗДЕЛ 18 ЗАКОНА СОЦСТРАХОВАНИЯ США), МЕДИКЕЙР, СТРАХОВАНИЕ ЗДОРОВЬЯ ПРЕСТАРЕЛЫХ И НЕТРУДОСПОСОБНЫХ
Japanese 老人および障害者の医療保険(アメリカ), 老人および障害者の医療保険第18項(アメリカ), メディケア(アメリカ)
French Système public d'assurance-santé pour les personnes de plus de 65 ans ou atteintes d'un handicap aux États-Unis, Système public d'assurance-santé pour les plus de 65 ans et les handicapés aux États-Unis, Medicare (USA), Health Insurance for Aged and Disabled (Medicare), Titre 18 de l'assurance santé des personnes agées ou handicapées aux États-Unis
Polish Program Medicare
German Medicare
Italian Medicare
Dutch Medicare, Ziektekostenverzekering voor ouderen en gehandicapten, artikel 18
Portuguese Health Insurance for Aged and Disabled, Title 18, Medicare
Spanish Health Insurance for Aged and Disabled, Title 18, Medicare
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Medicare Part A (C0079817)

Definition (MSH) The compulsory portion of Medicare that is known as the Hospital Insurance Program. All persons 65 years and older who are entitled to benefits under the Old Age, Survivors, Disability and Health Insurance Program or railroad retirement, persons under the age of 65 who have been eligible for disability for more than two years, and insured workers (and their dependents) requiring renal dialysis or kidney transplantation are automatically enrolled in Medicare Part A.
Concepts Regulation or Law (T089)
MSH D016344
English Hospital Insurance Program, Medicare, Medicare Hospital Insurance Program, Medicare Part A, Part A, Medicare, MEDICARE HOSP INSURANCE PROGRAM, MEDICARE A, HOSP INSURANCE PROGRAM MEDICARE, medicare part, medicare part a
Swedish Medicare del A
Czech Medicare - část A
Finnish Medicare osa A
French Medicare assurance hospitalisation (USA), Medicare A (USA), Medicare partie A, Medicare part A (USA), Assurance hospitalière Medicare (USA)
Russian MEDIKEIR, CHAST' A, MEDIKEIR, BOL'NICHNAIA PROGRAMMA STRAKHOVANIIA, BOL'NICHNAIA PROGRAMMA STRAKHOVANIIA, MEDIKEIR, БОЛЬНИЧНАЯ ПРОГРАММА СТРАХОВАНИЯ, МЕДИКЕЙР, МЕДИКЕЙР, БОЛЬНИЧНАЯ ПРОГРАММА СТРАХОВАНИЯ, МЕДИКЕЙР, ЧАСТЬ А
Polish Program Medicare cz.A
German Krankenhausaufenthalts-Versicherungsprogramm, Medicare-, Medicare Part A, Medicare-Krankenhausversicherungsprogramm
Italian Medicare Parte A
Dutch Medicare, deel A, Medicare, ziekenhuisverzekering, Ziekenhuisverzekering, Medicare
Portuguese Hospital Insurance Program, Medicare, Medicare Hospital Insurance Program, Medicare Part A
Spanish Hospital Insurance Program, Medicare, Medicare Hospital Insurance Program, Medicare Part A
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Medicare Part C (C0600580)

Definition (MSH) The Balanced Budget Act (BBA) of 1997 establishes a Medicare+Choice program under part C of Title XVIII, Section 4001, of the Social Security Act. Under this program, an eligible individual may elect to receive Medicare benefits through enrollment in a Medicare+Choice plan. Beneficiaries may choose to use private pay options, establish medical savings accounts, use managed care plans, or join provider-sponsored plans.
Concepts Regulation or Law (T089)
MSH D020398
English MEDICARE C, Medicare Part C, Part C, Medicare, Medicare Choice, Choice, Medicare Plus, Medicare Plus Choice, Plus Choice, Medicare, Medicare+Choice Program (US), Programs, Medicare+Choice (US), Medicare Plus Choice Program (US), Medicare+Choice Programs (US), Program, Medicare+Choice (US)
Czech Medicare - část C
Finnish Medicare osa C
Russian MEDIKEIR, CHAST' C, МЕДИКЕЙР, ЧАСТЬ C
Swedish Medicare del C
French Medicare C (USA), Medicare Plus Choice (USA), Medicare partie C, Medicare part C (USA)
Polish Program Medicare cz.C
German Medicare Choice, Medicare Part C, Medicare Plus Choice
Italian Medicare Parte C
Dutch Medicare Choice, Medicare Plus Choice, Medicare, deel C
Portuguese Medicare Choice, Medicare Part C, Medicare Plus Choice
Spanish Medicare Part C, Opcion Medicare Plus, Opcion Medicare, Opción Medicare Plus, Opción Medicare
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Medicare Part B (C0079818)

Definition (MSH) The voluntary portion of Medicare, known as the Supplementary Medical Insurance (SMI) Program, that includes physician's services, home health care, medical services, outpatient hospital services, and laboratory, pathology, and radiology services. All persons entitled to Medicare Part A may enroll in Medicare Part B on a monthly premium basis.
Concepts Regulation or Law (T089)
MSH D016345
English Medicare Part B, Medicare Supplementary Medical Insurance Program, Part B, Medicare, Program, SMI, Programs, SMI, SMI Program, SMI Programs, Supplementary Medical Insurance Program, Medicare, MEDICARE SUPPLEMENTARY MED INSURANCE PROGRAM, MEDICARE B, SUPPLEMENTARY MED INSURANCE PROGRAM MEDICARE, medicare part b, b medicare parts
Swedish Medicare del B
Czech Medicare - část B
Finnish Medicare osa B
Russian MEDIKEIR, CHAST' B, DOPOLNITEL'NAIA PROGRAMMA MEDITSINSKOGO STRAKHOVANIIA, MEDIKEIR, MEDIKEIR, DOPOLNITEL'NAIA MEDITSINSKAIA PROGRAMMA STRAKHOVANIIA, ДОПОЛНИТЕЛЬНАЯ ПРОГРАММА МЕДИЦИНСКОГО СТРАХОВАНИЯ, МЕДИКЕЙР, МЕДИКЕЙР, ДОПОЛНИТЕЛЬНАЯ МЕДИЦИНСКАЯ ПРОГРАММА СТРАХОВАНИЯ, МЕДИКЕЙР, ЧАСТЬ Б
French Assurance médicale complémentaire Medicare pour les soins ambulatoires (USA), Medicare B (USA), Medicare part B (USA), Medicare partie B, Assurance Medicare complémentaire (USA)
Polish Program Medicare cz.B
German Medicare Part B, Ergänzendes medizinisches Versicherungsprogramm, Medicare-, Medicare-ergänzendes medizinisches Versicherungsprogramm
Italian Medicare Parte B
Dutch Aanvullende medische verzekering, Medicare, Medicare, aanvullende medische verzekering, Medicare, deel B
Portuguese Medicare Part B, Medicare Supplementary Medical Insurance Program, Supplementary Medical Insurance Program, Medicare
Spanish Medicare Part B, Medicare Supplementary Medical Insurance Program, Supplementary Medical Insurance Program, Medicare
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Medicare Part D (C1955953)

Definition (MSH) A stand-alone drug plan offered by insurers and other private companies to beneficiaries that receive their Medicare Part A and/or B benefits through the Original Medicare Plan. It includes Medicare Private Fee-for-Service Plans that do not offer prescription drug coverage and Medicare Cost Plans offering Medicare prescription drug coverage. The plan was enacted as the Medicare Prescription Drug, Improvement and Modernization Act of 2003 with coverage beginning January 1, 2006.
Concepts Regulation or Law (T089)
MSH D054524
English Medicare Part D, Part D, Medicare
Portuguese Medicare Part D
Spanish Medicare Part D
Finnish Medicare Part D (U.S.)
French Couverture Medicare des médicaments délivrés sur ordonnance (USA), Assurance Medicare pour les médicaments sur ordonnance (USA), Prise en charge Medicare des médicaments prescrits par ordonnance (USA), Medicare part D (USA), Medicare partie D
German Medicare Part D
Italian Medicare parte D
Russian MEDIKEIR, CHAST' D, МЕДИКЕЙР, ЧАСТЬ D
Swedish Medicare del D
Czech Medicare - část D
Polish Program Medicare cz. D
Japanese メディケアパートD
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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