Medicaid
Along with Medicaid, this program provides health insurance for nearly 40% of all children (2021).
What is CHIP? (Children’s Health Insurance Program)
This landmark legislation expanded Medicaid eligibility, created state health insurance exchanges, and imposed an individual mandate, among other changes.
What is the ACA?
Medicare has four components – this one covers inpatient care, skilled nursing facilities, home health care, and hospice.
What is Part A?
This is a list of drugs covered by your health plan, and is often divided into tiers with different cost-sharing.
What is a formulary?
It is important to clarify that this individual who serves as the president of ICER is not related to our SVP.
Who is Steve Pearson?
Receiving a whopping $360B per year, these entities provide covered services to roughly 70% of all Medicaid beneficiaries.
What are MMCOs? (Medicaid Managed Care Organizations)
Released in 1999, the song ‘Bills, Bills, Bills’ was performed by which Grammy-nominated artist?
What is Destiny's Child?
DOUBLE JEOPARDY: The 1999 thriller Double Jeopardy finds this actress framed for murdering her husband.
(Disclaimer: I don't know how Jeopardy works and at this point I'm too afraid to ask)
Who is Ashley Judd?
Also called the coverage gap, this original part of the Part D design is not so sweet.
What is the donut hole?
In one of the last HCS games we played, Claudia said this was her favorite color.
States who want to undertake experimental or pilot projects to improve their Medicaid programs may do so through this expenditure authority request.
What is an 1115 Waiver/Demonstration?
The Inflation Reduction Act limits monthly cost sharing for this drug to $35.
What is insulin?
This independent congressional agency advises Congress on issues affecting the Medicare program.
What is MedPAC? (Medicare Payment Advisory Committee)
It sounds like a new retirement account, but it actually stands for recent legislation that creates price negotiation and inflation caps in Medicare.
What is the IRA? (Inflation Reduction Act)
2023 will whisk away this lovely component of our SD meetings.
Who is Lauren?
Also known as “match,” this figure represents the federal government’s share of a state’s qualifying Medicaid expenditures.
What is FMAP? (Federal Medical Assistance Percentage)
A 2022 IRS rule fixed this costly insurance issue, which had prompted affected individuals to get creative – and sometimes divorced – for coverage.
What is the family glitch?
To help pay for certain health care services not covered by FFS Medicare, some beneficiaries opt for this wrap policy.
What is Medigap / Medicare Supplemental Insurance?
Before CMS imposed a national coverage decision, some estimated this new drug could cost Medicare up to $57B annually.
What is Aduhelm?
The limbo zone between finishing a client proposal and having a signed contract may require you to request this code.
What is an at-risk code?
Medicaid is the primary payer for this critical service category, utilized primarily by older adults and people with disabilities, which is NOT covered by Medicare.
What is LTSS? (Long Term Services and Supports)
Though passed in 1976, this legislative provision that bars the use of federal funds to pay for abortion has become a hot button issue today.
What is the Hyde Amendment?
People younger than 65 may be eligible for Medicare if they have a disability, permanent kidney failure, or this disease.
What is ALS / Lou Gehrig’s disease?
These third-party administrators manage prescription drug benefits. But do they save you money? That’s up for debate.
What are PBMs? (Pharmacy Benefit Managers)
What did NORC originally stand for?
What is the National Opinion Research Center?