Health Insurance Basics
This is the amount paid regularly to maintain health insurance coverage, whether or not healthcare is used.
What is a premium?
This program was created in 1997 to insure children whose families earned too much for Medicaid but could not afford private insurance.
What is CHIP?
Having health insurance does not necessarily guarantee this outcome, as provider participation and appointment availability may differ.
What is equal access to care?
This branch of government drafts laws and controls federal spending.
What is the Legislative Branch?
Most wealthy countries have health systems that achieve this level of insurance coverage.
What is universal or near-universal coverage?
The amount a patient must pay before insurance begins contributing to covered services.
What is a deductible?
This jointly funded federal-state program provides coverage for eligible low-income populations.
What is Medicaid?
In the Maria and James scenario, this factor contributed to longer wait times for James.
What is lower Medicaid reimbursement/provider participation?
Medicare and Medicaid were signed into law by this president in 1965.
Who was Lyndon B. Johnson?
The United States relies primarily on this type of insurance arrangement.
What is a voluntary private insurance system?
A patient owes 20% of a covered service while insurance pays 80%.
What is coinsurance?
This public insurance program primarily covers Americans aged 65 and older and can include people with disabilities.
What is Medicare?
According to KFF data discussed in class, healthcare costs are not the only barrier; another type of barrier prevents people from getting care, and includes transportation, provider availability. What type of barrier is this?
What are access barriers (or nonfinancial barriers)?
This major healthcare law created health insurance Marketplaces and expanded access to coverage.
What is the Affordable Care Act (ACA)?
This quality aim is violated when patients with similar clinical needs receive different levels of care because of characteristics such as income, race, ethnicity, or geographic location.
What is equity?
This enrollment period generally occurs annually and allows individuals to purchase Marketplace coverage.
What is Open Enrollment?
This Medicare component covers physician services, outpatient care, and preventive services.
What is Medicare Part B?
The principle that healthcare resources and opportunities should be distributed fairly across populations.
What is health equity?
Under the U.S. constitutional framework, public health authority is divided among these levels of government.
What are federal, state, and local governments?
This payment system provides hospitals with a fixed payment based on diagnosis rather than charging for every service individually.
What is the Diagnostic Related Group (DRG) system?
An employer-sponsored account that allows workers to use pre-tax dollars for eligible healthcare expenses but is generally tied to employment and subject to annual rules.
What is a Flexible Spending Account (FSA)?
Research shows physician participation tends to be lower in this program because reimbursement rates are often lower than other health insurance reimbursement rates.
What is Medicaid?
Even after gaining insurance coverage, residents of medically underserved areas may still struggle to obtain timely care because they live in these regions lacking sufficient providers.
What are healthcare deserts?
This health insurance company practice was designed to control costs and manage appropriate utilization of healthcare services.
What is prior authorization?
This Medicare payment method uses Relative Value Units (RVUs) to determine physician reimbursement.
What is the Resource-Based Relative Value Scale (RBRVS)?