Individual Medical Expenses

Question 1

Are companies that provide Major Medical Insurance Plans typically private or public?

Answer 1

Typically private

Question 2

2 types of Major Medical Insurance Plans

Answer 2

1. Comprehensive Major Medical - Typical plan you have as W2
2. Catastrophic Major Medical - Horrible high deductible, low premium kind you had while unemployed

Question 3

7 characteristics of Major Medical Insurance

Answer 3

1. No maximum coverage limits
2. Deductibles
3. Co-payments
4. Benefit period
5. Coinsurance
6. Maximum out of pocket
7. Exclusions

Question 4

True or False

An individual policy holder (of medical insurance) cannot be singled out for rate increases.

Answer 4

True; everyone’s rate increases and in most cases state insurance departments must review and approve increases.

Question 5

True or False

Health insurance companies have the option to not renew a policy once it has ended

Answer 5

False; they can only be cancelled by insurers because of non-payment, fraud, misrepresentation, etc.

Question 6

What is Medicaid? Who funds it? Who manages it?

Answer 6

A health/long term care insurance program for people with LOW INCOMES and LIMITED RESOURCES

State & Fed funded

State managed

Question 7

What is Medicare? Who funds it? Who manages it?

Answer 7

Medical insurance program that provides coverage for people 65 and older. (Must meet other special criteria)

Funded by Medicare Taxes

Managed by the Fed

Question 8

In order to be eligible for MEDICARE, you must… (3 main things…)

Answer 8

Have worked 10 years in Medicare covered employment

Be a US citizen/permanent resident

Be 65 years or older, or have
- ALS
- End Stage Renal Disease
- Received Social Security Disability for 24 months
- Receive disability pension from Railroad Retirement Board

Question 9

What does Part A of MEDICARE consist of? (3 things)

Answer 9

1. Premium (no premium if worked 40+ medicare covered quarters of employment)
2. Deductible
3. Coinsurance

Question 10

True or False

Deductibles and Coinsurance (for MEDICARE) are incurred according to type of care required

Answer 10

True; inpatient hospital care, Hospice care, home healthcare, blood transfusions, etc.

Question 11

True or False

You can only use Medicare Part A or Medicare Part B depending on medicare covered quarters of employment. You can’t use both.

Answer 11

False; Medicare Part B is designed to supplement Part A, but you can choose to only use Part A

Question 12

What is Part B of MEDICARE intended to cover? (2 things)

Answer 12

1. Physician Services
2. Outpatient Hospital Services

Question 13

What is a Medigap Policy (Health Insurance Stuff)

Answer 13

Sold by private insurers to fill the gaps in Original Medicare Plan Coverage

Question 14

What are Medicare Advantage Plans (AKA Medicare Part C)

Answer 14

Medical expense plan option that are approved by Medicare but are run by private companies

(higher premiums, lower copays, more benefits)

Question 15

Describe how Health Maintenance Organizations (HMOs) work (as Medicare Part C)

Answer 15

Type of Advantage Plan (Medicare Part C) that is:

• Provides medical care on a pre-paid basis to volunteer enrollees in a specified geographic area
• Widely available
• Plans must cover Medicare A & B
• Can only go to doctors, specialists, hospitals in plan (except emergencies)

Question 16

Describe how Preferred Provider Organizations (PPOs) work (as Medicare Part C)

Answer 16

Type of Advantage Plan (Medicare Part C)

• Available in local/regional areas
• Pay less by using in-network doctors, hospitals, and providers
• Premiums may be higher than HMOs but lower than PFFs

Question 17

Describe how Private Fee-for-Service Plans (PFFs) work

Answer 17

Type of Advantage Plan (Medicare Part C)

• Private insurance companies provide access to medical services for members
  -Not restricted to a network, but could save by using in-network
  -High Premiums

Question 18

Describe how Medicare Special Needs Plans work

Answer 18

Type of Advantage Plan (Medicare Part C)

• Provides all Part A and Part B
• limited to people
  — in certain institutions (eg nursing home)
  — eligible for both Medicare/Medicaid
  or
  — with certain chronic or disabling conditions

Question 19

Generally what is Medicare Part D about?

Answer 19

Prescription Drug coverage for people with extensive medication needs