Key Terms
The amount of money an individual pays (normally on a routine basis) for their healthcare policy to the insurance company.
What is a premium?
The age when you may begin to be covered by Medicare
What is 65+?
True or False: Medicaid is only for the older population.
What is "false"?
The type of Managed Care Organization that is a "blend" of the other two.
What is Point of Service (POS)?
In order to recieve Medicare B, you must pay this.
What is a (monthly) premium?
Another name for fee-for-service.
What is retrospective payment?
Another name for Medicare Advantage Plus.
What is Medicare part C?
The level of government which regulates Medicaid.
What is state (state government)?
Group of physicians/hospitals providing discounts to specific groups/organizations for medical care.
What are Preferred Provider Organizations (PPOs)?
Another name for an indemnity plan.
What is fee-for-service plan?
Designated list of prescription drugs of which the insurance plan will cover the cost.
What is formulary?
The part of Medicare that diagnostic testing and preventative care falls under.
What is Medicare part B?
There may or may not be a premium due for Child Healthcare +, depending on this.
What is household income?
The Managed Care Organization that requires a fixed monthly fee.
What are Health Maintenance Organizations (HMOs)?
Name something that indemnity plans often will NOT cover.
What is preexisting conditions?
Name at least two factors that are taken into account when calculating Prospective Payments/Diagnosis Relating Groups.
What are age, diagnosis, and admitting diagnosis?
Identify what Medicare Part D is responsible for covering.
What are prescription drugs?
Name a group that can fall under both Medicare and Medicaid.
Who are those who are disabled?
The main goal of Managed Care Organizations.
What is to provide high quality care for a population (affordably and efficiently), while adhering to funding constraints
A benefit of self-pay.
What is a discount for when one pays up front with cash?
The normal percentage rate the INDIVIDUAL pays with co-insurance.
What is 20%?
People with these diseases are guaranteed enrollment into Medicare.
What is End Stage Renal Disease (ESRD) and Lou Gehrig's Disease (ALS)?
Two requirements to be eligible for enrollment in Child Healthcare +
What is being under 19 and a NYS resident?
The groups that ended up disadvantaged after the enactment of CONSUMER strategy of Managed Care Organization.
Who are the poor and disabled?
3 of the areas Medicare A will cover.
What are hospital stays, skilled nursing facilities, home healthcare, hospice, and inpatient psychiatric procedures?