Medicare
The age requirement to be covered by Medicare
65+
Medicaid is regulated at this level of government
State government
This managed care organization is a combination of HMO and PPO
POS - Point of service
The other name for indemnity plans
Traditional fee for service
DAILY DOUBLE
What is Ann Perkins' occupation in Parks and Rec?
Nurse :)
This part of Medicare covers prescription drug costs
Medicare Part D
19
This organization has patients pay a fixed monthly fee for membership
HMO - Health Maintenance Organization
The main advantage of indemnity plans over managed care organizations
Flexibility and "self-referrals"
The other name that refers to Medicare Part C
Medicare Advantage Plan
Covers outpatient, doctor's visits, and medical equipment
Medicare Part B
This term refers to those who do not qualify for Medicaid but cannot afford private insurance
Medicaid Gap
They generally supply insurance through managed care organizations
Employers
T/F - this plan is generally cheaper than other insurance plans
False - A main disadvantage is that these plans are more expensive
This form of insurance is the most common for the total population
Hospital, home health, skilled nursing, hospice
Give 3 examples of who receives Medicaid coverage
Elderly, low income, disabled, pregnant women, people who need nursing home care
This managed health organization does not require a PCP referral
PPO - Preferred Provider Organization
How do the insurance companies determine how much to pay for claims?
With the usual, customary, and reasonable rate (UCR)
Amount that providers in a region typically charge for a service
Name one reason for a decline in employer sponsored insurance
Increased healthcare costs
Shift from manufacturing jobs
Increase in the number of low-income families
This plan gives the benefits of Private Insurance plans as the companies partner with Medicare (includes other Medicare parts along with Private Insurance)
Medicare Part C
Mary is 66 years old and falls under low income threshold. She would be considered ________ for government sponsored insurance
Dual eligible
How does managed care differ from conventional health insurance?
Providing services directly
Contracting with providers
DAILY DOUBLE
Does Ron Swanson from Parks and Rec use an indemnity plan?
No. Ron Swanson does not believe in insurance.
The 2 diseases covered by Medicare regardless of age
End stage renal disease and Lou Gehrig's disease