Medicare Basics
What is the minimum age requirement for Medicare eligibility (in most cases)?
65 years old
Who funds Medicaid?
Both federal and state governments
What does HMO stand for?
Health Maintenance Organization
What is the largest single funder of healthcare in the U.S.?
The federal government
What year was the ACA signed into law?
2010
Name the four parts of Medicare.
Parts A (hospital), B (medical), C (Advantage plans), D (prescription drugs)
What is the primary eligibility requirement for Medicaid?
Low income (determined by Modified Adjusted Gross Income - MAGI)
What is the main advantage of PPOs over HMOs?
More provider choices, no referrals required for specialists
What is the term for healthcare spending that does not improve patient outcomes?
Wasted care
Name one of the three primary goals of the ACA.
Expanding coverage, making insurance affordable, lowering healthcare costs
Which Medicare part covers hospital stays, hospice, and skilled nursing care?
Part A
True or False: Medicaid is the same in all states.
False – States can tailor their Medicaid programs within federal guidelines
What is a deductible?
The amount a patient pays before insurance starts covering costs
What is a "surprise medical bill"?
A bill from an out-of-network provider that a patient did not choose
How did the ACA expand Medicaid?
Allowed states to cover adults with incomes up to 138% of the Federal Poverty Level (FPL)
What is the main difference between Medicare Part B and Medicare Part C?
Part B covers outpatient care, while Part C is a private plan bundling A, B, and sometimes D
What percentage of all births in the U.S. are covered by Medicaid?
Over 50%
What percentage of Americans receive health insurance through their employer?
About 56%
Which three factors contribute most to excess healthcare spending?
Unnecessary services, administrative costs, inefficient care delivery
True or False: The ACA requires insurers to cover people with preexisting conditions.
True
Why do many Medicare recipients buy supplemental insurance policies (Medigap)?
To help cover out-of-pocket expenses like deductibles and copayments
What is the Medicaid “coverage gap”?
A situation where individuals earn too much for Medicaid but not enough for ACA subsidies
What is the "maximum out-of-pocket" cost?
The most a patient will pay for covered services in a year
What is the term for care that balances cost, benefit, and harm?
High-value care
True or False: The U.S. spends more on healthcare per capita than any other country.
True