Medicare Basics
A federal insurance program for adults 65+ or under 65 with disabilities or ESRD.
What is Medicare?
Inpatient hospital care, skilled nursing, hospice, and limited home health.
What does Medicare Part A cover?
A joint federal–state program for low-income individuals.
What type of program is Medicaid?
To control costs, coordinate care, and improve efficiency.
What is the purpose of managed care?
Traditional fee-for-service insurance allowing any provider choice.
What is an indemnity plan?
In 1965 under the Social Security Act.
When was Medicare established?
Outpatient care, doctor visits, preventive services, and durable medical equipment.
What does Part B cover?
Children, pregnant women, seniors, and people with disabilities.
Who does Medicaid cover?
HMO — Health Maintenance Organization.
Which plan requires referrals and uses in-network providers?
They are more expensive and lack cost-control features.
Why are indemnity plans less common today?
CMS — Centers for Medicare & Medicaid Services.
Who administers Medicare?
Medicare Advantage — combines Parts A and B, often with Part D.
What is Part C known as?
By both the federal and state governments.
How is Medicaid funded?
PPO — Preferred Provider Organization.
Which plan allows more flexibility but has higher costs?
The insurance company.
Who decides “usual and customary” rates in indemnity plans?
Through payroll taxes, premiums, and federal revenue.
How is Medicare funded?
Prescription drug coverage through private plans.
What does Part D cover?
New York’s state insurance program for children under 19 who don’t qualify for Medicaid
What is Child Health Plus?
Point of Service plan — hybrid of HMO and PPO.
What does POS stand for?
Managed care uses networks and referrals; indemnity does not.
What’s a major difference between managed care and indemnity plans?
Older adults and certain disabled individuals.
What population does Medicare primarily serve?
A = Hospital, B = Doctor, C = Combined, D = Drugs.
What’s an easy way to remember the four parts?
Checkups, dental, vision, and prescriptions.
What services does CHP cover?
Prevention and efficiency in patient care.
What’s a key focus of managed care organizations?
Greater provider choice but higher out-of-pocket costs.
What’s the main trade-off with indemnity plans?