Health Insurance Intro Flashcards
A ______ is the entrance fee to have health insurance. It is a pre-payment. The insurer negotiates prices and pays for some share of services on your behalf
Premium
Nearly all insurance plans involve some degree of cost sharing. _____ are what you pay out of pocket. There are two forms of cost sharing: _______ is you pay a set percent of the price of a given service. ______ is you pay a set amount for the price of a given service.
Deductibles
Co-insurance
Co-payment
Cost sharing implications are highly studied. Three key points: people do respond to ____ in healthcare (people use more services if they are cheaper). Even small amounts of cost sharing can ____ service use. Individuals cut back on the more and less clinically important services in response to _____ cost sharing
Prices
Deter
Higher
Health insurance plans define the ____ of providers that the insurer will pay.
Network
Insurance arrangements may involve ______ _____ (ex: prior authorization) these are things that the insurer does to exert some control over the services being used
Utilization management
Insurers negotiate _____ with providers
Fees
The fundamental tension of health insurance: we want some cost to prevent people from ______ healthcare BUT increasing cost sharing will increase ______ costs for those who needs care and prevent people from using clinically important services
Overusing
Out of pocket
Types of insurance in the US
_____ million of Americans were uninsured in 2019. ______% of the non elderly were uninsured
29.2
10.8
The main reason why people are uninsured is because ____ is too high
Cost
Almost ____% of uninsured people live above the poverty line but below what is would take for insurance to be considers affordable on the open market
80
_____ doesn’t cover everyone over 65- you must have paid in and be a permanent resident or citizen and lived in the US for the past 5 years
Medicare
_____ varies by state and covers only the lowest income residents and a subset with documented disabilities who qualify and renew their paperwork
Medicaid
Only ___% of uninsured people live in a household with no employment
15
Medicare part __ is automatic, anyone who is a citizen and has worked and paid taxes qualifies
Medicare part __ is voluntary, enroll and pay a premium
A
B
CMS stands for Center of Medicare and Medicaid services
Review
Part A covers hospital and post hospital _____ care
Part B covers ____ care
Inpatient
Outpatient
Traditional Fee for service Medicare does not cover ____ or ____. It does not cover ____ care. It does cover outpatient _____ and ____ physicals
Heading aids
Glasses
Long-term
Medications
Preventative
There are still out of pocket costs for Medicare including _____, _____, and ____
Premium, coinsurance, deductible, copayment
The part A detectable in 2021 is _____. You are responsible for paying this amount if you’re hospitalized. Then insurance kicks in. The part B deductible is ____ per year
$1484
$203
_____ insurance is a payment to CMS to pay for some of the costs that are not covered by traditional Medicare. Cost $70 to $750 per month
Supplemental
The payment follows the service. Fee for service Medicare money goes to _____ and _____
Hospitals
Physicians
Medicare advantage is part ___. People enroll in a Medicare advantage health plan, CMS provides an amount of money to that MA health plan. Then patients engage the healthcare system, that MA plan reimburses the hospital and patients for the services provided. The more people that join the plan, the more money the MA health plan receives from CMS
C
The MA plan has ____ over the last few years. Why? CMS created this MA plan so they are saving money through transferring the risk onto MA instead of them. If MA is more efficient than CMS, they make money as well
Grown
Medicare part ___ is prescription drug coverage
D
Diagram:
Part D plans have premiums, copays, etc. they also have _____ that vary in price. The ____ ____ (donut hole) refers to when people spend a lot of money of prescription medications there is a level where coverage stops
Tiers
Coverage gap
_____ covers disabled people and people who are economically disadvantaged
Medicaid
Medicare is a ____ program, Medicaid is both a ____ and ___ program
Federal
Federal and state
____ million people enrolled in Medicaid in 2021. $600 billion was spent on Medicaid and $800 billion was spent on Medicare in 2019
75
____ set its own criteria for Medicaid coverage
States
Diagram
Diagram
For a family of 4 with kids, Minnesota gives about _____ per year
$75,000
_____% of MN population is covered by Medicaid
17
A lot of what Medicaid is used for is ____ care
Long term
