Medicare
Which Medicare part covers prescription drugs?
Part D
What financial status (level of income) is Medicaid provided for?
Low-income
Are managed care organizations categorized as public or private insurance?
Private
True or false?
Indemnity plans can help cover the cost of specific healthcare circumstances
True
What is a set amount determined in your policy that you will need to pay to the healthcare provider for each visit
Copay
True or False:
You can obtain Medicare Part B without being eligible for Part A
False
What ages are covered under the state Child Health Plus Program?
Children under the age of 19
Point of Service has the characteristics of which 2 other managed care organizations?
Health Maintenance Organization (HMO) & Preferred Provider Organization (PPO)
True or False?
Indemnity plans are the most restrictive type of insurance in regards to allowing the patient to choose their preferred provider or hospital
False
What is a list of medications that the insurance will cover for a lower cost?
Formulary
What types of drugs are NOT covered by law in Medicare Part D?
Weight loss/gain drugs, OTC drugs
True or False?
Each state operates its own Medicaid program
True
What organization involves the consumer paying a fixed price for a monthly membership for healthcare?
Health Maintenance Organization (HMO)
Bob is under an indemnity insurance plan. He lives in NY and wants to see a doctor in Texas for his treatment. Under this plan, can Bob receive covered care from the doctor in Texas? Explain.
Yes. Indemnity plans allow patients to self-refer themselves to any doctor of their choice, regardless of geographic location. Bob will have to pay the difference between the plan's payment and the provider's bill.
What is a set amount determined in an insurance policy that must be payed first for health care services before the insurance company will begin to pay?
Deductible
At what age do U.S. citizens/permanent residents become eligible for Medicare?
65+
Who funds the Medicaid program?
Both the federal and state government
What organization utilizes the practice of reimbursement for the employees they cover?
Preferred Provider Organization (PPO)
What is the amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same medical service?
UCR rate
What type of payment revolves around the number of patients/customers using the service?
Capitation
How many days is a patient covered in a hospital setting admitted by a physician under Medicare Part A?
90 days
What are 3 types of services covered under Medicaid?
Hospital/Physician care, Lab tests, X-rays, Immunizations, Dental/Vision care, Nursing home visits, relevant medical equipment, hospital stays, etc.
What are 2 issues regarding managed care organizations?
Loss of customary provider/preferred hospital, Restricted access to specialty tests & Restricted medication access
What type of "traditional" insurance type are indemnity plans known for?
Fee-for-service insurance
Regarding incrementalism, are changes in policy occurring rapidly or slowly?
Slowly