Assignment 12 - Retiree Coverage Flashcards
About what percentage of Medicare beneficiaries have some type of supplemental health insurance?
more than 90% have such coverage.
List the (4) types of retiree health coverage other than Medicare
- retiree health coverage
- Medigap plans purchased individually
- Medicare Advantage plans
- Medicaid.
Medicaid provides coverage to these individuals because they have sufficiently low income that they are: (4)
- (1) eligible for Supplemental Security Income
- (2) “qualified Medicare beneficiaries,”
- (3) “specified low-income beneficiaries,”
- (4) covered under an optional state Medicaid program.
Employer-sponsored retiree coverage is primarily a ____ phenomenon
large firm
If a person is covered by Medicare and also by an employer-sponsored plan, which coverage is primary and which is secondary?
employer is primary
What are the three alternative methods of coordination that a private retiree plan can use to determine its payment obligation as the secondary payer behind Medicare?
- (1) the coordination-of-benefits method,
- (2) the carve-out method and
- (3) the exclusion method.
Medigap plans are required to have a medical loss ratio (MLR) of ___ in the individual market and ___ in the group market.
65%
75%
Are Medigap policies underwritten?
yes and state regulated
Issue-age policies are cheaper than attained-age policies for _____ purchasers because an issue-age policy holds a constant premium into the future, while an attained-age policy increases with the individual’s age.
younger
Medicare expenditures are higher as a result of the various Medicare supplemental plans. The reason has to do with:
moral hazard.
The vast majority of enrollment in Medicare Advantage plans has been in:
health maintenance organization (HMO) plans.
