Chapter Recap
This chapter explained health insurance available to senior citizens and special needs individuals: Medicare, Medicare Supplements, Medicaid, and Social Security Disability. Let's recap some of the key points:
SOCIAL SECURITY BENEFITS
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Basics
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- OASDI - Old Age, Survivors, and Disability Insurance
- Provides disability income benefits
- Individual must meet proper insured status, definition of disability, and waiting period requirements
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| Qualifying for Disability Benefits |
- Individuals must have earned 40 work credits (4 each year), 20 of which were earned in the 10 years before the disability
- 5-month waiting period
- Benefits based on PIA
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WORKERS COMPENSATION
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Eligibility
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- Work in Workers Compensation-covered occupation
- Suffer a work-related injury or sickness (regardless of fault or negligence)
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Benefits
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- Medical benefits
- Income benefits
- Death benefits
- Rehabilitation benefits
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MEDICARE
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Basics
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- Federal medical expense insurance program for people who:
- Are age 65 or older
- Have been entitled to Social Security disability income benefits for 2 years
- Have a permanent kidney failure (ESRD)
- 4 parts:
- Part A, Hospital Insurance, financed through payroll tax (FICA)
- Part B, Medical Insurance, financed by insureds and general revenues
- Part C, Medicare Advantage, allows for receipt of health care services through available provider organizations
- Part D, Prescription Drugcoverage
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Part A
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- Enrollment:
- Initial enrollment period -when an individual first becomes eligible for Medicare (starting 3 months before turning age 65, ending 3 months after the 65th birthday)
- General enrollment period -between January 1st and March 31st each year
- Special enrollment period - at any time during the year if the individual or his/her spouse is still employed and covered under a group health plan
- Coverage:
- Inpatient Hospital Care
- Skilled Nursing Facility Care
- Home Health Care
- Hospice Care
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Part B
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- Optional; offered to everyone who enrolls in Part A
- Coverage:
- Doctor Services
- Outpatient Hospital Services
- Home Health Visits
- Other Medical and Health Services
- Prescription Drugs (limited coverage)
- Outpatient Treatment of Mental Illness
- Yearly "wellness" visit
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Part C
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- Medicare Advantage: requires enrollment in Parts A and B
- Provided by an approved Health Maintenance Organization or Preferred Provider Organization
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Part D
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- Prescription drug benefit
- Optional coverage through private prescription plans that contract with Medicare
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Primary, Secondary Payor
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- For individuals eligible for Medicare coverage who continue to work, the employer’s health plan would be primary coverage while Medicare would be secondary coverage
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MEDICAID
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Purpose
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- Medical care for those whose income and resources are insufficient
- Federal and state funded
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7: Which of the following is an eligibility requirement for all Social Security Disability Income benefits?
A Be at least age 50
B Have attained fully insured status
C Be disabled for at least 1 year
D Have permanent kidney failure
Although Social Security offers many benefits, such as retirement, survivors and Medicare, only those who have attained fully insured status are eligible for Disability Income benefits. Contributing to Social Security for 40 quarters (10 years) attains fully insured status.
10: Workers Compensation benefits are regulated by which entity?
A Insurer
B Federal government
C State government
D Employer
The state government offers and regulates Workers Compensation benefits, which vary slightly from state to state.
15: What is a penalty tax for nonqualified distributions from a health savings account?
A 8%
B 10%
C 12%
D 20%
An HSA holder who uses the money for a nonhealth expenditure pays tax on it, plus a 20% penalty.