Exam 3 Flashcards
What are the 2 broad categories of health disparities?
health STATUS disparities
health CARE disparities
Which health disparity encompass disparities in health care access, quality, and outcomes?
health CARE disparities
Which health disparity does the following define?:
“differences that occur by gender, race or ethnicity, education or income, disability, living in rural localities or sexual orientation”
STATUS
Which health disparity does the following define?:
“differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the united States. Research on health disparities related to socioeconomic status is also encompassed in the definition”
STATUS
Which health disparity does the following define?:
“racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of interventions”
CARE
What are the 3 measurement categories of health?
structural
process
outcome
What is considered a difference in healthcare delivery?
clinical indications and patient preferences
What is considered a disparity in healthcare delivery?
systemic factors such as resources or access and biases, stereotyping, and uncertainty
______ is a tool to advance public health as well as define and enforce rights and responsibilities within the healthcare and public health systems.
law
What is a situation in which everyone has the opportunity to attain his or her full health potential?
health equity
What part of medicare is for hospital/inpatient services?
part A
What part of medicare is for physician/outpatient services?
part B
What part of medicare is for managed care plans (Medicare Advantage)?
part C
What part of medicare is for prescription drug plans?
part D
Which part(s) of Medicare has mandatory enrollment?
part A
Which part(s) of Medicare has voluntary enrollment?
parts B, C, D
Which part(s) of Medicare is financed through a mandatory 2.9% payroll tax?
A
Which part(s) of Medicare is financed through a general federal tax revenue?
B
Which part(s) of Medicare is financed through annual deductibles?
B and D
Which part(s) of Medicare is financed through parts A, B, and D?
C
Which part(s) of Medicare is financed through monthly premiums?
B and D
Which part(s) of Medicare is financed through deductibles for each day of in-patient stay?
A
Which part(s) of Medicare is financed through hospital care after 60 days and skilled nursing facility care after 20 days?
A
Which part(s) of Medicare is financed by Medicare paying the insurance company a capitated rate for covering the beneficiary?
C
Which part(s) of Medicare has a complicated cost-sharing structure that is known as the “doughnut hole”?
D
Which part(s) of Medicare is financed through a sliding scale of a small additional premium if income is more than $85,000/$170,000?
D
Which part(s) of Medicare provides some subsidies to help with premium and cost-sharing for those with incomes under 150% FPL with modest assets.
D
What is Medigap?
Supplemental insurance
Why would someone choose to have Medigap?
to cover out-of-pocket costs not covered by A and B
Does Medigap give you access to additional services or coverage?
no
Is Medigap a federally regulated plan?
yes
What is meany by “dual eligibles”?
When Medicaid helps pay for Medicare’s premiums and cost sharing for Medicare beneficiaries with low income and modest assets.
What does MACRA stand for?
Medicare Access and CHIP Reauthorization Act
What prohibits Medicare supplemental insurance (Medigap) policies from covering the Part B deductible for people who become eligible for Medicare on or after January 1, 2020?
MACRA of 2015
Why was MACRA of 2015 put into place?
due to Moral Hazard
Which part(s) of Medicare provides comprehensive coverage that usually includes prescriptions?
C
Which part(s) of Medicare limits out-of-pocket spending?
C
Can you have both Medigap and Medicare Advantage?
no
Those enrolled in which parts of Medicare can also enroll in Medigap?
A and B
What are some services that are not covered under Medicare?
vision
dental
hearing aids/hearing exams
nursing homes
Why might an individual select traditional Medicare over Medicare Advantage?
traditional Medicare does not vary based on geographic location
3 main “pathways” to Medicare eligibility.
- over 65 AND qualify for SS benefits
- disability: must qualify for SS Disability Income AND have been collecting benefits for 24 months
- diagnoses of ESRD, ALS, and receiving SSDI payments
To received Medicare eligibility, do you need to be a U.S. citizen or legal resident?
yes
Is long-term care covered with Medicare Part A?
no
There is a 10% __________ for each year a person is eligible but not enrolled in Part B.
penalty
Is Medicare free for the beneficiary?
no
Why might someone choose to have Medicare Advantage over traditional Medicare?
MA has more benefits, it it comprehensive coverage, and it allows you to budget.
How are nursing homes paid for in the US?
through Medicaid
What type of purchasing is the Medicare Reimbursement Policy moving toward?
value-based purchasing
What does it mean for Medicaid to be an entitlement program?
that the government is supposed to provide benefits to a certain population
How many low-income Americans does Medicaid cover?
1 in 5
As enacted, the ACA Medicaid expansion would cover adults up to ___% FPL in all states, filling long-standing gaps in coverage.
138
What is an exception to Medicaid coverage?
undocumented residents are not covered and states are not required to cover legal residents during first 5 years in the US.
What group of people does the federal government match funds for under Medicare?
pregnant women and children who are legal immigrants with less than 5 years of residency
What does EPSDT stand for?
early
periodic
screening
diagnosis
treatment
__________ benefits reflect the needs of the population that it serves.
Medicaid
What percentage of Medicaid spending is for long-term care?
40%
What are eligible individuals entitled to with Medicare?
a defined set of benefits
What are states entitled to under Medicare?
the federal government matching funds
What is the federal governments role under the federal-state partnership through Medicaid?
to set core requirements on eligibility and benefits
What is the states role under the federal-state partnership through Medicaid?
states have the flexibility to administer the program within federal guidelines
What percentage does the federal government pay for Medicaid?
57%
What percentage of the states budget does Medicaid take up?
17-20%
CHIP covers children under what age?
19 y/o
Is CHIP or Medicaid a more flexible program
CHIP
CHIP takes care of some of the gaps in what insurance plan?
Medicaid
Can children covered by CHIP be eligible for Medicaid?
no
Is CHIP an entitlement program?
no
Are the benefits for CHIP more or less defined than for Medicaid?
less
Is dental a required benefit for CHIP?
yes
________ has a higher FMAP called EFMAP.
CHIP
What population does CHIP try to cover?
the near poor
What are 3 reasons why states like CHIP?
- high match by the federal government
- flexibility that it provides in coverage
- ability to charge premiums
What are the 3 parts of the CHIP Congressional Intent?
- reduce the number of uninsured children
- build on Medicaid but not as an entitlement
- gives states flexibility
How does the enrollment and spending of CHIP compare to Medicaid?
much less
What services are optional with CHIP but not with Medicaid?
vision and hearing
What 3 things are federal funds allotted to states based on?
- recent CHIP spending
- adjusted annually for child population growth
- medical inflation
How many years does states have to spend each allotment for CHIP?
2
For CHIP, states that use allotted funds and exceed target enrollment are also eligible for what?
contingency fund payments
For CHIP, the federal government provides matching funds like Medicaid but federal funds are __________ for each state.
capped
There is reduced matching from the federal government for CHIP for covering children over ___% FPL
300
What are the top 2 reasons why families enroll their children in CHIP?
affordability
health care need
