Medicare 是聯邦健康保險計劃,主要針對 65 歲及以上人士,以及符合資格的較年輕殘疾人士或末期腎臟病患者。Medicaid 則主要是基於收入。Medicaid 是一項聯邦與州政府共同資助的計劃。聯邦政府制定核心規則,但各州管理各自的計劃,並決定許多資格細節與福利。大約有 1,200 萬美國人具有雙重資格,這意味著他們同時參加了這兩項計劃。Medicaid 通常幫助這些人支付 Medicare 的保費、免賠額和費用分攤。Medicare Part A 是醫院保險。它涵蓋住院護理、專業護理機構護理(在特定條件下)、臨終關懷和某些居家健康服務。Part B 是醫療保險。它涵蓋醫生服務、門診護理、預防性服務、耐用醫療設備及其他一些服務。Medicare 涵蓋有限的專業護理機構護理(通常在符合條件的住院後最多 100 天)。它不涵蓋長期的生活照護型護理。Medicaid 是長期護理中心護理的主要公共支付方。對於大多數受益人,2025–2026 年的標準 B 部分保費約在 185 至 203 美元之間。高收入人士則需通過 IRMAA 調整支付更多費用。Medicaid(醫療補助)是長期服務與支持的主要支付方,負擔了大部分療養院居民以及許多居家和社區服務的費用。擴展州份通常涵蓋收入不超過聯邦貧窮線 138% 的成年人(法定 133% 加上 5% 的收入豁免)。D 部分是自願性的處方藥福利。受益人可以透過獨立的 D 部分計劃或透過許多聯邦醫療保險優勢計劃(Medicare Advantage)獲得。大多數受益人可獲得免保費的 A 部分,因為他們或其配偶已繳納聯邦醫療保險稅至少 40 個季度(10 年)。Medicaid 是為低收入人群設計的,因此大多數參加者只需支付極少甚至無需支付自付費用。Medicare 通常則需要支付保費、免賠額和共同保險。Medicare Advantage (Part C) 計劃由私營公司提供,且必須承保至少與原始 Medicare (Part A 和 B) 相同的福利。許多計劃還包括 Part D 藥物承保和額外福利。Medicaid 承保多個強制性和選擇性群體,其中兒童和孕婦擁有最廣泛的資格途徑。受益人在達到年度自付額後,通常需要為大多數 Part B 服務支付 20% 的共同保險。原始 Medicare 沒有自付費用上限。全額福利的雙重資格者以及參加 Medicare 儲蓄計劃 (QMB, SLMB, QI) 的人士可以透過 Medicaid 獲得 Medicare 費用方面的補助。原始 Medicare 對牙科、視力和聽力服務的承保非常有限。部分 Medicare Advantage 計劃將這些作為補充福利提供。大約五分之一的 Medicare 受益人(約 1,200 萬人)具有雙重資格,同時也領取 Medicaid。雖然聯邦法律設定了最低要求,但各州在資格標準(特別是針對自選群體)和承保的自選福利方面具有靈活性。Part A 自付額適用於每個福利期。在患者連續 60 天未接受住院治療或專業護理服務後,新的福利期即開始。Medicaid 是長期服務和支援的主要公共支付方。Medicare 僅在符合條件的住院後提供有限的專業護理機構服務。Part A 自付額在 2025 年為 1,676 美元,2026 年上升至約 1,736 美元。它是按每個福利期收取的,而不是每年一次。這些由州政府管理的計畫使用 Medicaid 資金,幫助符合條件的低收入 Medicare 受益人支付 Part B(有時也包括 Part A)的保費及其他費用。Medicare Advantage 計劃是與 Medicare 簽約的私人計劃。它們必須提供至少與 A 部分和 B 部分相同的福利,且通常包含額外的福利,如牙科、視力或處方藥保障。原始 Medicare 通常支付大多數 B 部分服務核准金額的 80%,受益人需負擔 20% 的共同保險(且無年度自付費用上限)。聯邦規則和各州選擇通常為兒童和孕婦設定比其他成年人群體更高的收入資格門檻。Medicare A 部分為預期壽命在六個月或以下,並選擇接受臨終關懷服務的受益人提供保障。當失業率上升或收入下降時,更多人符合 Medicaid 資格,從而導致加入人數以及州/聯邦支出增加。聯邦醫療保險不涵蓋看護性質(非技術性)的長期護理。醫療補助(Medicaid)是為符合條件的個人支付此類護理費用的主要公共計畫。聯邦醫療保險是主要付款方。醫療補助作為次要付款方,通常支付剩餘的費用分攤以及聯邦醫療保險不涵蓋的服務。各州通常將醫療補助和兒童健康保險計畫(CHIP)的收入資格設定為聯邦貧困線(FPL)的百分比,不同的百分比適用於不同的群體。D 部分是自願性處方藥福利。受益人可以參加獨立的 D 部分計畫,或透過許多聯邦醫療保險優勢計畫(Medicare Advantage)獲得藥物保障。擴張計畫使參與州中收入不超過 138% FPL 的非老年成年人(包括無子女者)具備獲得醫療補助的資格。大多數人支付標準的 B 部分保費,但高收入受益人需支付與收入相關的每月調整金額(IRMAA),這會增加其保費。Medicaid 是長期療養院照護的主要支付方,涵蓋了很大比例的居民,尤其是那些已經耗盡資產的人。與大多數私人保險和 Medicare Advantage 計劃不同,原始 Medicare 對 A 部分和 B 部分的受益人年度自付支出沒有上限。聯邦政府分擔州政府 Medicaid 支出的部分比例(即聯邦醫療協助百分比,簡稱 FMAP)。分擔率因州而異,較貧困的州和特定人群的分擔率較高。在符合條件的至少三天的住院治療後,Medicare 可以在每個福利期內涵蓋長達 100 天的專業護理機構照護,第 20 天後需支付共同保險。原始 Medicare 通常不包含常規的牙科、視力及聽力服務。這些保障在 Medicare Advantage 補充福利中較為常見,而 Medicaid 的保障則因州而異。雙重資格是指一個人符合 Medicare(通常因年齡或殘疾)且同時滿足其所在州的 Medicaid 財務資格規定,從而允許 Medicaid 協助支付 Medicare 費用及提供額外服務。You scored 0 out of 40You scored 1 out of 40You scored 2 out of 40You scored 3 out of 40You scored 4 out of 40You scored 5 out of 40You scored 6 out of 40You scored 7 out of 40You scored 8 out of 40You scored 9 out of 40You scored 10 out of 40You scored 11 out of 40You scored 12 out of 40You scored 13 out of 40You scored 14 out of 40You scored 15 out of 40You scored 16 out of 40You scored 17 out of 40You scored 18 out of 40You scored 19 out of 40You scored 20 out of 40You scored 21 out of 40You scored 22 out of 40You scored 23 out of 40You scored 24 out of 40You scored 25 out of 40You scored 26 out of 40You scored 27 out of 40You scored 28 out of 40You scored 29 out of 40You scored 30 out of 40You scored 31 out of 40You scored 32 out of 40You scored 33 out of 40You scored 34 out of 40You scored 35 out of 40You scored 36 out of 40You scored 37 out of 40You scored 38 out of 40You scored 39 out of 40You scored 40 out of 40
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聯邦醫療保險(Medicare)與醫療補助(Medicaid)是美國規模最大且最重要的兩項公共衛生計劃,兩者合計覆蓋了數千萬美國人,並在聯邦與州政府支出中佔據顯著比例。然而,許多人對於誰具備資格、實際涵蓋哪些服務、政府支付多少費用,以及這兩項計劃的差異仍感到困惑。\r\n本測驗旨在測試您對基礎知識及一些最常被誤解之細節的理解。您將遇到關於資格規定、Medicare 的不同組成部分、Medicaid 通常涵蓋哪些 Medicare 未涵蓋的內容、雙重資格、費用分攤,以及政府在支付住院、護理中心護理及日常醫療服務中所扮演的角色等問題。我們將難度設定為中等,以便具備美國醫療體系一般知識的人都能參與,同時仍能揭示讓許多人感到意外的知識缺口。\r\n準備好看看您對納稅人實際資助的內容了解多少了嗎?讓我們開始吧。
答對 21–30 題
聯邦醫療保險(Medicare)與醫療補助(Medicaid)是美國規模最大且最重要的兩項公共衛生計劃,兩者合計覆蓋了數千萬美國人,並在聯邦與州政府支出中佔據顯著比例。然而,許多人對於誰具備資格、實際涵蓋哪些服務、政府支付多少費用,以及這兩項計劃的差異仍感到困惑。\r\n本測驗旨在測試您對基礎知識及一些最常被誤解之細節的理解。您將遇到關於資格規定、Medicare 的不同組成部分、Medicaid 通常涵蓋哪些 Medicare 未涵蓋的內容、雙重資格、費用分攤,以及政府在支付住院、護理中心護理及日常醫療服務中所扮演的角色等問題。我們將難度設定為中等,以便具備美國醫療體系一般知識的人都能參與,同時仍能揭示讓許多人感到意外的知識缺口。\r\n準備好看看您對納稅人實際資助的內容了解多少了嗎?讓我們開始吧。