Medicaid
How much of the federal poverty level does your income need to qualify as a low-income family?
138% FPL
What does CHIP stand for?
Children's Health Insurance Program
Who qualifies for Medicare?
65+, end-stage renal disease, disability
Jai has asthma and changed jobs. His new insurer says they can charge him more because of his condition.
Is that allowed under the ACA? Why/why not?
Not allowed. Under the ACA, plans can’t charge more or deny coverage due to pre-existing conditions.
Name members of EBoard. (100 points for each one)
Srilekha
Dilan
Amae
Connor
Sunjum
Aran
Lexi
Anjali
I just got on Medicaid, and I just made an appointment to see my primary care provider. The only problem is, my PCP lives a 45-minute drive away, and I don’t have access to a car. Would you be able to help me get to the doctor’s office?
Medicaid provides free transportation
Does CHIP have presumptive eligibility?
Yes
True or False: If you have medicare, private insurer can sell a marketplace plan even if they know consumer has medicare coverage.
False
Name 4 different metal plans
Bronze, Silver, Gold, Platinum
Where are you supposed to sign up for events?
On the events calendar, under the shadowing section!
Until what age can you get health insurance coverage under your parents’ health plan?
26
Who is CHIP for?
Uninsured children up to age 19 whose family income is too high for them to qualify for Medicaid
Low-income pregnant individuals and/or newborns in some states who don’t qualify for Medicaid
What is Part A, B, C, and D?
A: Hospital Insurance
B: Medical Insurance
C: Medicare Advantage Plans
D: Prescription Drugs
Sam’s job plan covers some doctor visits but excludes inpatient hospital care and only pays about half of total costs. Premiums seem cheap.
Does this plan meet Minimum Value? If not, how could that affect Sam’s eligibility for PTCs on the Marketplace?
It doesn’t meet Minimum Value (needs ~60% coverage and substantial hospital + physician benefits). Because it fails Minimum Value, Sam may be eligible for Premium Tax Credits (PTCs) on the Marketplace.
What's my name?
Dilan
What is used to determine financial eligibility?
MAGI - Modified Adjusted Gross Income
New mothers who lose insurance qualify for marketplace special enrollment period of __ days.
60
What part can have no premium?
Part A
True or False: Under ACA, health insurance companies are required to provide an SBC, free of charge, written in easy-to-understand knowledge.
True
What are our 2 branches?
Projects
Events
[Social Media and Fundraising]
What is the difference between an HMO vs PPO?
HMO: Only covers in-network services. less flexible, lower in cost
PPO: Covers in-network, and out-of-network service. More flexibility, higher cost
Name 3 services or benefits that CHIP covers
Routine checkups
Immunizations
Doctor visits
Prescriptions
Dental and vision care
Inpatient and outpatient hospital care
Laboratory and X-ray services
Emergency services
COVID-19 testing, treatment, and vaccinations
Joel has Part A medicare but wants Premium Tax Credits or Cost Sharing Reductions. Is this possible? If not, what do you recommend he does.
No.
Medicare Savings Programs (MSPs)
Qualified Medicare Beneficiary Program (QMB) covers everything
Specific low-income medicare beneficiary (SLMB) program covers part B premiums
Qualifying Individual (QI) program cover part B premiums
Qualified Disabled and working individuals (QDWI) program that pays for Part A
Jordan’s household income is 240% of the Federal Poverty Level (FPL). He qualifies for Premium Tax Credits (PTCs) and is deciding between:
A Bronze plan with the lowest monthly premium, OR
A Silver plan that costs a bit more but offers CSR benefits.
If Jordan chooses the Bronze plan, what important financial help will he miss out on, and why is the Silver plan potentially the smarter choice despite the higher premium?
Jordan will miss out on Cost Sharing Reductions (CSRs), which only apply to Silver plans.
CSRs lower deductibles, copays, and out-of-pocket maximums, making healthcare more affordable when he actually needs care.
Even if the Bronze plan’s monthly premium is cheaper, the Silver plan could save Jordan much more overall when he uses medical services.
What are requirements to be a new member?
Shadow 1 SCHO Event
3 total SCHO Hours
No more than 2 absences
Meet 2x with big-little
Go on 2 coffee chats with old members of club