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41 Cards in this Set
- Front
- Back
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oasdhi aka social security
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go to office. Federal Program, get a check, on average 2185 dollars a month for a couple, some living on $700 a month. Worth fighting for- cant become rich in social security
Eligibility: poor, means test, medicare program, do not have to have paid taxes, just certain level of insurance, |
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OASDHI OR SSB
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FEDERAL PROGRAM
welfare INSURANCE PROGRAM |
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OASDHI OR SSB
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ELIGIBLE FOR MEDICARE
RETIREMENT OLD AGE DISABILITY SURVIVORS |
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TANF
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STATE PROGRAM
ASSISTANCE PROGRAM Eligibility: Assistance program State program Means test: <17% of Fed Pov Level or <$3400 /yr/fam of 4 Deprived of support of one parent Legal aliens- immigration papers Disliked the most Hard to stay on, very strict, have to be very poor Benefit is cash or other voucher support In 2005 $269 per mo for fam of 3 Cannot be on this program for longer than 2years accumulutaive in a lifetime Mothers with very young children, effort to get them jobs and off off |
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MEDICARE eligibiltiy
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OVER 65
LONG TERM DISABILITY, ESRD Payed into for working ten years at a palced that took out FICA, also eligible for spouse. |
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Medicare part A
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Hospitalization, home health after hosp.
Deductibles, no premiums . Push for people to get managed/advantage plans, work like HMO, limited range of hospitals, preset portfolio of care Prospective Payment (DRG’s): stand for diagnostic related groupings, for every diagnosis there is a preset amount of money that hospital gets payed, hospital know show much money the hospital will get and how many days patient can stay that will get payed. If not out within preset amount of days, hospital eats the cost. How hospitals get payed. |
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Medicare part b
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MEDICAL EXPENSES
Premiums Deductibles Coinsurance Coverage: MD, non-routine dental, podiatry, out pt care, in 2005 added PE’s, DM, hearing/vision screening ___ ends up paying because no insurance wants to foot the bill for the elderly Medigap polcy, picks up the gaps in medicare coverage Lab and x-ray, mostly outpatient care NO DRUGS |
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medicare part D
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Prescription Drug Plans
Covers unlimited # of Rx on formulary Private carriers contracted by feds Monthly premium ($25 in 2008) Deductible & Coinsurance $275 initial deductible From $275-$2510 pt pays 25% & plan pays 75% From $2510 to $4050 pt pays 100% (called the “donut hole”) Above $4050, pt cost-shares ($2.25 -5.60/drug, plan pays the rest) (called Catastrophic coverage) |
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MEDICAID
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STATE PROGRAM
ASSISTANCE PROGRAM Eligibility: some high income requriements for other states, Texas is at the bottom, very low requirements in texas means its stingy. In 2010 familiy of 4 should earn less than 22,000, considered under poverty. Single mother and pregnant, should earn 1.5 times of poverty State only kicks in 28cents per dollar California pays 50% of healthcare medicaid, so get reimbursed more federally Texas Health Steps: well child care at private dr. offices as well |
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CHIP
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Medical, dental care for children in families above the Medicaid cut-off (incomes >$1667/mo and <$3334)*
Costs up to $50 / 6 mo. with $3-10 co-pay for meds Plans vary by county ACTS LIKE AN INSURANCE PLAN, but from the state. Many families do not re-enroll in program and avoid to pay the 50$ every 6moths |
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SS Income
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FEDERAL ASSITANCE PROGRAMS
Disabled and low income, check to live on, long term mental disabilities, long period of time, children with learning disabilities, get on then get back off, unable to work, unable to bring money in. building-not simiral to ss, low income and disabled ppl. |
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FOOD STAMPS
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FEDERAL ASSISTANCE PROGRAM
debit card, money is applied to card on monthly levels, cut levels are higher than medicaid, money comes from Department of agriculture, hangs in there, administered thru department of human services |
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Federal and Insurance programs
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Medicare a, b, d
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includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor's office. Medication administration is covered under Part B only if it is administered by the physician during an office visit.
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medicare part b
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deferred is spuse still working
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medicare part B
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Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered
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medicare part B
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limited range of hospitals, DRG making it hard on hospital to accept patients on _____.
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medicare part a
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mostly provided by the state, but helped federally
Assistance program |
Medicaid
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Federal and welfare insurance program
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OASDHI aka social security
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Federal and assistance programs,
for low income and disabled people |
SOCIAL SECURITY INCOME CHECK
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State assistance program
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TANF
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state insrance program
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CHIP
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FEDERAL ASSISTANCE PROGRAM
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FOOD STAMPS
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voluntary
non-governmental, non-taxable meet needs of special groups |
private sector
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no legal power
addresses special needs not addressed or serviced by the U.S. GOVT american heart assoc visiting nurse assoc american cancer society planned parenthood children shelters Santa Rosa |
private non profit
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must pay expenses and stockholders
cost efficient home health agencies nursing personnel pools medical equipment supply comp drs, nurses, social workers psychologists lab and radiologists |
private for profit
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government health agencies
contributory and non-contributory |
public sector programs
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MEDICARE
MEDICAID CDC NIH FDA |
DEPARTMENT OF HEALTH
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tax supported
proper sewage disposal provision of sanitary waste environmental pollution highway safety communicable disease control record keeping, vital stats conduct research finicially support other community health efforts |
public sector health services
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detecting unment needs
exploring better methods fro meeting needs prmoting public knowledge assiting official agencies with innovative programs public advocacy role evaluating official programs assuming a public advocacy role prmoting health legislation collaborate with voluntary services and official agencies developing well bakanced community health programs |
private non profit funcitons
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school heatlh services
health educationk-12 health promotion for faculty and staff/ employee health cunselingpsychologicaland social services physical education programs healthy school environment familiy and community involvement (partnership among schools, families and community groups |
School health programs
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medicaid used to be billed, but not anymore
they used to cover case magmt for chronic illnesses like diabetes and asthma also helped pay for the nurse |
school nurse funding
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individualized health plans
school nurse |
special needs chronic conditions
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School nurses
Special education programs |
individualized education programs to develop health magmt for students
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reduce services covered
reduce amt paid/reimbursed to MDs increasing payments by enrollees do no pay nosocomial infections |
medicare approaches to control costs
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commercial
premiums deductibles and co- insurance operate under special state enabling laws that give them exclusive franchise to the whole state or part of it to a specific type of insurance tax exempt so subject to tighter state regulation |
private non profit insurance
blue cross/blue shield hospital coverage and medical insurance |
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fixdd pre-paid costs
use din both private and public sector care is managed by regulating use of services & levels of provider care payment control ocst by managing utilization and provider payments HMOs and PPOs |
managed care
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prepayed fixed mothly premium to receive healthcare services delivered by a DEFINED network of service
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HMOs
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contract with 3rd party, choose providesrs in the plan
can go to specialist instead of being referred by primary dr |
PPO
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provide health care benefits for children whose needs are not met by toehr programs
will provide checups, surgeries, most have big congenital health problems |
public assitance
CSHCN: children with sepcial health care needs |
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UNITED WAY
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private sector
assistance programs |
