Medicare
Main purpose of Medicare.
Assist the elderly with healthcare costs.
______ qualifies for Child Health Plus.
Children younger than 19 years old
Purpose of Managed Care Organizations.
Reduce healthcare costs.
Indemnity Plans are also known as....
Fee-for-service insurance
What does health insurance do?
Covers a portion an individual's medical costs.
Medicare part D covers....
Cost of prescription drugs.
Medicaid is funded by.....
The government and the state
Types of Managed Care Organizations.
Health Maintenance Organizations(HMOs)
Preferred Provider Organizations(PPOs)
Point of Service Organizations(POS)
Client can choose any medical provider.
True or False
True
“Efforts made to maintain, restore, or promote someone’s physical, mental, or emotional well-being especially when performed by trained and licensed professionals.”
Healthcare
Medicare sold by private companies.
Medicare Part C (Medicare Advantage Plan)
Determines Medicaid income eligibility.
MAGI- Modified Adjusted Low Income
Characteristics of both an HMO and PPO.
Point of Service plan
Advantages to an Indemnity Plan.
Patient can self-refer and are not restricted by geography and region.
What does Medicare Part C cover?
Medicare parts included in the original plan.
Medicare parts A and B
Determines Medicaid income eligibility for individuals exempt from MAGI-based counting.
SSI- Supplemental Security Income
Federal law that promotes and encourages the development of health maintenance organizations.
Health Maintenance Organization Act
Disadvantages to Indemnity Plan.
May cost more and UCR rates
Health Insurance plan that client can use any medical provider.
Indemnity Plans
Not covered by Medicare.
Dental care, eye exams, dentures, cosmetic surgery, massage therapy
Medicaid non-financial eligibility qualifications.
resident of the state, U.S. citizen or qualified non-citizen
Are Managed Care Organizations public or private sponsored?
Private
How do Indemnity Plans work?
Patient sends medical bill to insurance company, which pays a portion of the bill.
What is the difference between Medicare and Medicaid?
Medicare assists the elderly (65+) and Medicaid provides for low-income individuals.