Potpourri
Prior to this act, health insurance could refuse could refuse to cover you for a "pre-existing condition"
Affordable Care Act
Government insurance program for persons of all ages whose income and resources are insufficient to pay for health care
Medicaid
Federal insurance program that people age 65 and older are eligible for
Medicare
What resource does Weill Cornell Medicine offer to uninsured patients?
Weill Cornell Community Clinic (WCCC)
Age until when young adults can stay on their parent’s health insurance plans
26
The amount one pays monthly to maintain their health insurance
Premium
The amount one has to pay out-of-pocket for their health services before his/her health insurance kicks in
Deductible
The time frame during which I can purchase health insurance
During the open enrollment periods
The most one will ever have to pay for their health services as long as they stay in network
Out of pocket maximum/limit
A plan that covers care provided by an in-network physician, where care is coordinated by a primary care physician
Health Maintenance Organization (HMO)
An amount of medical expenses that the holder must pay before the insurance kicks in
Deductible
Early in January, Robert visits an in-network doctor to get a wart removed from his foot. The bill for this visit is $530, which is the member rate the doctor agreed to charge his health plan for that service. Robert has a $30 co-pay, a $100 deductible, and 20% coinsurance that apply for this visit. His co-pay does not count towards the deductible. Robert pays this much for the visit?
30+100+(.20*(530-130)) = $210
3 factors that are used to help determine the premium one pays
Age, location, tobacco use, individual vs family enrollment
Medicare Prescription Drug Coverage
Medicare Part D
Your insurance will not cover these expenses because you went to Dr. X, who is out of...
Network
List 3 benefits that all health insurance plans must provide.
Ambulatory services; emergency services; hospitalization for surgery and overnight procedures; pregnancy, maternal, & newborn care; mental health services; prescription drugs; rehabilitation services; laboratory services; preventative services as well as chronic disease management; pediatric services
Alternative to Original Medicare, Part A and Part B. Instead of having Medicare benefits administered through the government-run program, beneficiaries can choose to get their coverage through private insurance companies that contract with Medicare.
Medicare Advantage Plans
Patient pays a standard amount (i.e., $50 copay for urgent care visit); versus patient pays a percentage of the total cost of the service they received
Copay vs. Coinsurance
Which insurance plan will cover costs from services you receive in and out of network?
Preferred provider organization (PPO)
What is it called when one provides false or misleading information to health insurance companies in an attempt to procure unauthorized benefits?
Health Insurance Fraud
This country's national health service utilizes cards with embedded microchips that can be presented to one’s doctor or pharmacist and that when swiped will enable reimbursement without a paper-based claim.
France
Information that insurance companies receive about people’s health
Billing codes & diagnoses
For these 2 conditions you can receive Medicare under the age of 65
ALS and end-stage renal disease treated with dialysis
The federal and state insurance program that provides health insurance to children below the age of 18 whose families have incomes too high to qualify for Medicaid but too low to afford private insurance
Children’s Health Insurance Program (CHIP)
Many American dread "socialized medicine." Give three examples of such in the US
Medicare, Medicaid, the VA