5. Overview of the Business of Health Care Delivery (Medicare/Medicaid) Flashcards
Health Insurances
Consumer insurance payment =
premium
Health Insurances
annual amount consumer pays before insurance covers services =
deductible
Health Insurances
amount consumer pays each time service is provided =
copay / coinsurance
Health Insurances
who are the primary financiers of managed care
Employers and government
Health Insurances
Is the most dominant health care delivery system in the United States and available to most Americans:
managed care organizations
Health Insurances
Medicare Part 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
Health Insurances
Provides health insurance for inpatient hospital services, short-term nursing home care, and home healthcare
Medicare Part A
Health Insurances
Which Medicare part covers outpatient health services including PT, diagnostic tests, visits to the doctor, etc.?
Part B (voluntary)
Health Insurances
Medicare + Choice, now known as Medicare Advantage
Medicare Part C
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?
Medicare Part C
Health Insurances
Includes prescription drug benefits for Medicare Part A and Part B enrollees
Medicare Part D
Health Insurances
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
Medicare Part D
Health Insurances
is extended nursing home care a Medicare benefit?
no
Health Insurances
Medicare benefits include only medical services and
treatments considered necessary and reasonable supported by _________ standards of care
evidence-based
Health Insurances
enrollment limited to people below certain limited income and asset levels
MEDICAID
