4/8 Flashcards
Name the four major problems of the US healthcare delivery system.
- Rising healthcare expenditures
- Large number of uninsured in the population
- Considerable waste and inefficiency
- Harmful insurer practices
Each plan under the Affordable Care Act has annual ___ that limit the amount insureds must pay in the form of deductibles, coinsurance, copayments, etc.
Out-of-Pocket Limits
A(n) ___ states that a percentage of the bill in excess of the deductible, which the insured must pay out-of-pocket up to some maximum annual dollar limit.
Coinsurance provision
A(n) ___ is a flat amount the insured must pay for certain benefits, such as an office visit or generic drug.
Copayment
The insured’s total out-of-pocket spending is limited by an annual out-of-pocket limit (aka ___), after which the insurer pays 100% of eligible expenses.
Stop-Loss limit
A(n) ___ is a tax exempt account established exclusively for the purpose of paying qualified medical expenses.
Health Savings Account
___ pays a daily or monthly benefit for medical or custodial care received in a nursing facility, in a hospital, or at home.
Long-term care insurance
Which type of long-term care insurance matches the following description?
- Policies reimburse for actual charges up to a daily limit
- Consumers have a choice of daily benefits, which range from $50 to $350
- Policies may cover a different amount depending on the type of facility
- Policies may have limits on the total amount paid over the lifetime of the policy
Expense-incurred (or reimbursement) policies
___ (or per diem policies) are long-term care insurance policies that pay a flat dollar amount per day regardless of actual expenses.
Indemnity policies
A(n) ___ is a waiting period during which time benefits are not paid.
Elimination period
In a qualified long-term care insurance plan, a(n) ___ must be met to receive benefits. Either,
- The insured is unable to perform a certain number of Activities of Daily Life (ADLs), or
- The insured needs substantial supervision to be protected against threats to health and safety because of a severe cognitive impairment
Benefit trigger
Most insurers for LTC policies offer optional ___, which provides benefits if the insured lapses the policy.
Nonforfeiture benefits
Some states have ___ designed to reduce Medicaid expenditures by eliminating or reducing incentives of some people to rely on Medicaid to pay for long-term care.
Long-term Care Partnership Programs
___ provides income payments when the insured is unable to work because of sickness or injury. These income payments are typically limited to 60-70 percent of gross earnings.
Disability-income Insurance
Under the Affordable Care Act, ___ are paid out by insurance companies if they don’t follow the minimum medical loss ratio.
Rebates