5. Overview of the Business of Health Care Delivery (Medicare/Medicaid) Flashcards Preview

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Flashcards in 5. Overview of the Business of Health Care Delivery (Medicare/Medicaid) Deck (18)
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1
Q

Health Insurances

Consumer insurance payment =

A

premium

2
Q

Health Insurances

annual amount consumer pays before insurance covers services =

A

deductible

3
Q

Health Insurances

amount consumer pays each time service is provided =

A

copay / coinsurance

4
Q

Health Insurances

who are the primary financiers of managed care

A

Employers and government

5
Q

Health Insurances

Is the most dominant health care delivery system in the United States and available to most Americans:

A

managed care organizations

6
Q

Health Insurances

Medicare Part A:

A
  • Automatically enrolled at no cost at age 65 or otherwise eligible
  • Provides health insurance for inpatient hospital services, short-term nursing home care, and home healthcare
7
Q

Health Insurances

Provides health insurance for inpatient hospital services, short-term nursing home care, and home healthcare

A

Medicare Part A

8
Q

Health Insurances

Which Medicare part covers outpatient health services including PT, diagnostic tests, visits to the doctor, etc.?

A

Part B (voluntary)

9
Q

Health Insurances

Medicare + Choice, now known as Medicare Advantage

A

Medicare Part C

10
Q

Health Insurances

Which Medicare part requires higher premiums (social security deductions), but includes expanded benefit —no deductibles, smaller co-payments, no cost annual physical examinations, preventative diagnostic screens, prescription drug coverage, and health promotion programs?

A

Medicare Part C

11
Q

Health Insurances

Includes prescription drug benefits for Medicare Part A and Part B enrollees

A

Medicare Part D

12
Q

Health Insurances

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003

A

Medicare Part D

13
Q

Health Insurances

is extended nursing home care a Medicare benefit?

A

no

14
Q

Health Insurances

Medicare benefits include only medical services and
treatments considered necessary and reasonable supported by _________ standards of care

A

evidence-based

15
Q

Health Insurances

enrollment limited to people below certain limited income and asset levels

A

MEDICAID

16
Q

Health Insurances

mandates health insurance to children in families whose income and assets are too much to qualify for Medicaid, yet not enough for a obtaining a private insurance policy.

A

CHILDREN’S HEALTH INSURANCE PROGRAM

In some states, CHIP is part of the Medicaid program, in other states it is freestanding. Hybrid models are used in other states.

17
Q

Health Insurances

It covers at-risk infants and toddlers through early intervention programs

A

Individuals with Disabilities Education Act (IDEA) was revised as Individuals with Disabilities Education Improvement Act (IDEIA) in 2004.

18
Q

Health Insurances

supports special education in school systems.

A

Individuals with Disabilities Education Improvement Act (IDEIA)