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22 Cards in this Set
- Front
- Back
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How to apply for Medicare |
65+ automatically enrolled in Part A and B can opt out of B online |
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How to apply for Medicaid |
online |
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How to apply for Employer-Based Health Insurance |
x |
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Qualification criteria for Medicare |
A: 1. 65+, US citizen/perm residence for 5 years 2. <65, permanent disability, Social Security Disability Income (SSDI) for 24 months 3. End-Stage Renal Disease (ESRD), Amyotropic Lateral Sclerosis (ALS), as soon as start receiving SSDI payments B: same as A, automatic unless decline enrollment |
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Qualification criteria for Medicaid |
-US citizen/citizenship status, SS #, Ohio resident -differing financial requirements: 1. Children (0-18): 211% FPL 2. Pregnant Women: 200% FPL 3. Parents of dependent Children: 138% 4. Adults without dependent children: 138% 5. Disabled workers: 250% 6. Disabled: 138% *FPL depends on household size -up 10 400% FPL receive Exchange (w/ subsidies) |
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Different parts of Medicare |
A-Hospital Insurance (HI) Program -inpatient hospital stays, skilled nursing facility, some home health visits, hospice care B-Supplemental Medical Insurance (SMI) Program -physician, outpatient, some home health, preventive services C- Medicare Advantage Program -enroll in private plan (PPO, HMO) -receive all Medicare-covered benefits D- Outpatient Prescription Drug Benefit -Medicare Modernization Act (MMA) -private plans contract with Medicare to provide Medicare Advantage Prescription Drug plans (MA-PD) or stand-alone Prescription Drugs Plans (PDP) |
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Describe Medicaid funding |
1.federal and state -Federal Medical Assistance Percentage (FMAP): specified % (50%-83%) paid to state by fed - % based on per capita income of state - 100% federal funding for those that match to Medicaid under ACA -enhanced FMAP (eFMAP): children -90% of family planning -50% administrative costs 2.NOT funded by payroll deduction 3.largest payer of health care in state |
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Describe Medicare funding |
-Part A: 2.9% of earnings paid by employers and workers, 0.9% from higher-income tax-payers, fee-for-service -B: general revenues and beneficiary premiums -C: Medicare pays private plan -D: Enrollees pay monthly premium and cost sharing for Rxs, penalty if wait to enroll |
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Describe Employee-based funding |
Employer pays for most of premium, remaining premium cost out-of-pocket |
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HMO |
Health Maintenance Organization -lower monthly premiums -fewer options of care -designate PCP--> referrals for specialists -copay |
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PPO |
Preferred Provider Organization -higher monthly premium -larger network -out of network pay more -no PCP = no referrals |
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Employer Based Health Insurance |
Insurance provided to employees (and sometimes their children) through an employer |
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Health Insurance Policy |
x |
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Covered Services |
services paid for by insurance plan |
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Supplemental Insurance |
sold by private companies to help pay health care costs plan doesn't cover |
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Risk-pooling |
-risk management method -insurance companies come together to form a pool to provide insurance companies protection against catastrophic risks |
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Premium |
monthly payment |
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Cost-sharing |
share of costs covered by health insurance that is paid out of pocket includes: 1. deductibles 2. co-insurance 3. co-payments |
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HDHP |
High Deductible Health Plan -lowest premium -pay all costs until meet deductible -higher deductible=smaller monthly premium -coinsurance= % of bill insurance company pays once meet deductible -meet out of pocket maximum= insurance co pays 100% |
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Federal Poverty Level (FPL) |
2014: family of 4- $23,850 guidelines establislhed by US Dept Health and Human Services to determine eligibility for various federal and state programs |
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CHIP |
covers uninsured, low income children not eligible for Medicaid |
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ACA Marketplace |
-virtual insurance mega-mall -private insurance -pick out how much coverage you want and how much you want to pay for -fed will pay buyers tax credit -regulation of insurance companies |
