CFP 512 4 EXTRA QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS

CFP 512 4 EXTRA QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS Medicaid covers most health care costs, including hospital and doctor bills and custodial care in a nursing home. Medicaid is also required by law to pay Medicare premiums, deductibles, and coinsurance for Medicare-eligible Medicaid patients provides coverage for long-term care (LTC)—including nursing home care Medicaid law includes a provision defining a lookback period of 60 months for assets transferred to others Recall that Medicaid is a joint federal and state health insurance program. Generally, the program is administered by the states with financial assistance from the federal government. If a taxpayer elects to itemize, unreimbursed qualified medical expenses in excess of 7.5% of adjusted gross income (AGI) can be claimed as an itemized deduction. MAdatory benefits Inpatient hospital services Freestanding birth center services Outpatient hospital services Home health services Physician services Laboratory and X-ray services Early and periodic screening, diagnostic, and treatment services (EPSDT) Certified pediatric and family nurse practitioner services Family planning services Nursing facility services Federally qualified health center services Nurse midwife services Rural health clinic services Tobacco cessation counseling for pregnant women Nonemergency transportation to medical car Optional Medicaid Benefits The following are optional Medicaid benefits that states may cover if they choose: Clinic services Prescription drugs Physical therapy Speech, hearing, and language disorder services Respiratory care services Podiatry services Occupational therapy services Optometry services Dental services Health homes for enrollees with chronic conditions Targeted case management services Prosthetics Hospice services Eyeglasses Other licensed practitioners' services Dentures Personal care Medicare has 4 main aprts 1. Part A covers four main benefit areas: inpatient hospital care, posthospital extended care in a skilled nursing facility, posthospital home health services, and hospice care. 2. Part B pays physicians and for other outpatient treatment, certain preventive services, screening tests, and home dialysis, as well as other services. 3. Part C (Medicare Advantage) provides four program alternatives: Medicare HMO, PPO, private fee-for-service, and Medicare special needs plans. Medicare MSAs may also be available to supplement the basic coverage. 4. Part D provides prescription drug coverage. Each year, a deductible is set per occurrence of illness, which means that the client may pay this deductible more than once in a year if there are hospital stays a minimum of 60 days apart. The deductible is charged, but there is no coinsurance for days 1-60 of each benefit period. For hospital stays longer than 60 days and under 91 days, including readmission within 60 days of being released, there is a set copayment that changes annually. That copayment increases after the 91st day-150th day, which are considered lifetime reserve days. Clients have a total of 60 days over their lifetimes that qualify for these excess days. The copay for those days are set every year. If a patient remains in the hospital for more than 150 days within a benefit period, the total hospital costs beyond the 150 days are the responsibility of the patient. There is no limit to the number of benefit periods people can have during their lifetimes. Medicare only offers limited coverage under Part A for expenses related to long-term care (LTC). The insured must first stay in a hospital for at least three days and must also be expected to recover from the medical condition. Then, within 30 days, the individual must enter a Medicare-approved nursing home. As long as the care is provided at a skilled nursing level, benefits may be available for up to 100 days. Skilled nursing care essentially means that a registered nurse (RN) is available and supervises the care 24 hours per day, and the care is required by a physician. If this is the case, the first 20 days in the facility are fully paid by Medicare. The next 80 days are also covered, but with a daily coinsurance, which is established every year ($200 in 2023). After 100 days, the insured pays all costs. Medicare Part A helps pay in-hospital expenses. Medicare Part B helps cover physician's and outpatient expenses. Medicare Part C, or Medicare Advantage plans, is offered by private insurance companies and work similarly to group plans offered by employers. Two