All of the following are Part C benefits EXCEPT: a. Medicare ...

[KWilfred]

All of the following are Part C benefits EXCEPT:
 
  a. Medicare beneficiaries may choose to have covered items and services furnished to them through a Medicare HMO which is a private insurance company that will charge a premium and copays.
  b. If Medicare beneficiaries select this coverage, they are required to receive services according to the selected carrier's arrangements.
  c. When patients are enrolled in a Medicare HMO, claims for these patients must be submitted to the HMO.
  d. Seniors with these plans bill the remaining amounts or copays to Medicare.

Question 2

Explain the history, financial responsibility, medical coverage, and benefits of TEFRA/DEFRA.
 
  What will be an ideal response?

[mmj22343]

Answer to Question 1

D

Answer to Question 2

Answer:
The Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) and the Deficit Reduction Act of 1984and amendmentshave redirected the financial responsibility for medical coverage of active employees and their spouses age 65 years and older. When this federal program was introduced, it was determined that Medicare would be the primary payer for persons who have reached their 65th birthday, regardless of employment status.
Initially, TEFRA regulations did not apply to spouses over age 65 of active employees who were under 65 years of age. The Deficit Reduction Act of 1984 (DEFRA), effective January 1, 1985, amended TEFRA so that now spouses age 65 years and older of active employees who are under age 65 can elect their primary coverage as either Medicare or the private group plan.
The employers affected by these acts are those who regularly employ 20 or more workers for each working day in at least 20 weeks of the current or preceding calendar year. Employees of such employers must be offered coverage under the group plan on the same basis as other employees. An election form choosing the primary plan must be completed and signed by each employee who is, or becomes, affected.
If coverage is chosen under the employer's group plan, the group plan will be the primary payer on all medical services and Medicare will be the secondary payer. If coverage under the group plan is rejected and Medicare is chosen, the employee/spouse by law can be covered only by Medicare. The group plan will not provide secondary coverage.
Employers with fewer than 20 employees are exempt from the TEFRA/DEFRA regulations, and Medicare is the primary carrier for their active employees and spouses age 65 years or older. Medicare is also primary for all retired employees and for active employees and their spouses under age 65 who are totally disabled with conditions including end-stage renal disease (ESRD).