Medicare questions appear on every health and combined exam, and they are among the most predictable. Most of what you need is in two CMS publications, Medicare & You and Choosing a Medigap Policy.
The parts of Medicare
- Part A helps cover inpatient hospital care, and skilled nursing facility care after a hospital stay. Original Medicare stops paying for a skilled nursing facility after 100 days in a benefit period.
- Part B covers doctors' services and outpatient care, including durable medical equipment such as a walker or wheelchair a doctor prescribes.
- Part C is Medicare Advantage: private plans that deliver Medicare benefits.
- Part D helps pay for prescription drugs. To join a separate drug plan, a person must have Part A, Part B or both.
Drug plan rules
Part D plans can use step therapy: the plan covers a costly brand-name drug only after the member first tries a similar lower-cost drug. The annual Open Enrollment Period for joining, switching or dropping a drug plan runs from October 15 to December 7.
Medigap
Medicare supplement (Medigap) policies are private insurance that helps pay the costs Original Medicare leaves, such as deductibles and coinsurance. Points the exam tests:
- A Medigap policy issued since 1992 is guaranteed renewable: the insurer cannot cancel it except for nonpayment of premium or fraud.
- A Medigap insurer may impose a pre-existing condition waiting period of up to 6 months.
- Medigap works with Original Medicare. Medicare Advantage plans are not Medigap policies.
Medicare and Medicaid
Medicare is federal health insurance, mainly for people 65 and older; Medicaid is a government health program for people with limited income. A person can have both, and in many cases Medicaid pays the person's Medicare Part B premium.
Long-term care is a different product
Medicare covers skilled care for limited periods, not ongoing custodial care. Long-term care insurance fills that gap: most people who use long-term care receive it at home, benefits usually start after an elimination period during which the insured pays, and eligibility is often measured by activities of daily living such as transferring to or from a bed or chair.