Managed Care
The monthly or yearly amount paid to an insurance company for health insurance coverage.
What are premiums?
This Managed Care plan where you have to pick a primary physician, need a referral, and have to stay in-network
What is a HMO?
This is the government healthcare payment plan for uninsured children.
What is CHIP?
This part of a Medicare plan pays for Prescriptions
What is part D?
In return for federal, state, and local tax exemptions, these institutions must provide community benefits.
What are voluntary- nonprofit institutions?
The money a person pays before the insurance policy provides benefits.
What is the deductible?
This type of plan is very similar to an HMO plan but no referral is needed to see a specialist in the network
What is an EPO?
This plan provides medical coverage for active and retired service personnel and their dependents.
What is Tricare?
This part of a Medicare plan is the Medicare advantage plans that fill in the gaps in coverage
What is medicare part C?
The simultaneous presence of two or more diseases or medical conditions in a patient.
Comorbidities
Measures designed to lower health care costs.
What is Health Care Cost Containment?
This type of healthcare plan utilizes the HMO approach for in-network, but when you go out-of-network, you pay much higher prices than other plans. Referrals required
What is a POS
This type of account is offered by an employer and is usually paired with a Traditional Insurance policy. Money is put into a medical savings account and funds can be withdrawn for qualified medical expenses. The money must be spent every year
What is a FSA?
This part of a Medicare plan pays for outpatient services.
What is part B?
Reduces unplanned, 30-day hospital readmissions by penalizing hospitals with higher-than-expected rates for specific conditions.
The Hospital Readmissions Reduction Program (HRRP)
Type of care that consists of measures taken to prevent diseases.
What is preventive care?
If a person is 28 and starting out in their career and relatively healthy, this plan would be best if they aren't making a large salary.
What is an EPO?
This plan is both state and federally funded.
What is Medicaid?
Daily Double! Double Points!
The year the government created medicare and medicaid.
What is 1965?
This type of plan exists to provide affordable access to major medical expense coverage for younger, healthy people who don't expect to use a lot of healthcare services; must be 30 or qualify for a hardship exemption if older.
What is a catastrophic plan?
A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts.
What are pre-existing conditions?
This plan would have the highest out-of-network cost of all the managed care plans typically.
What is a POS?
DAILY DOUBLE*** Double Points!
A community clinic that provides healthcare to everyone, regardless of their ability to pay.
Federally Qualified Health Center (FQHC)
"A high-quality, government-supported clinic designed to make sure no one is left without a doctor"
The system that pays a provider a fixed amount that is based on the medical diagnosis or procedure.
Prospective payment system.
Name two government institutions.
What are VA hospitals, state mental hospitals, and state rehabilitation facilities?