Insurance Flashcards
Medicare part A covers
Skilled nursing services in certain conditions for a limited time
Medicare part A conditions are as follows:
-The member has Part A and has days left to use in the benefit period
-Has a qualifying hospital stay (3 day inpatient within 30 consecutive days, sometimes can be waived)
-A physician has determined that the member needs daily skilled care in a SNF
HMO
A health maintenance organization is an organization that provides health coverage with providers under contract. A Health Maintenance Organization differs from traditional health insurance by the contracts it has with its providers.
Indemnity plan
Indemnity plans allow you to direct your own health care and visit almost any doctor or hospital you like. The insurance company then pays a set portion of your total charges. Indemnity plans are also referred to as “fee-for-service” plans.
Medicare
the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
Medicare Advantage Plans
A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
Medicare Advantage Plans. Managed Medicare
plans typically require precert for SNF placement. Ask SNF referrals if in doubt. Precerts typically take 1-2 days, and expire within 48 hrs of approval, so plan precert initiation wisely!
Medicare Part C
is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage Plans.
Medicare Part B
(medical insurance) is part of Original Medicare and covers services and supplies that are medically necessary to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment.
Medicare Part D
also called the Medicare prescription drug benefit, is a United States federal-government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries
Medicare Supplement Insurance
AKA Medigap policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and deductibles
Medicaid
A program that offers health insurance to certain low-income families, individuals with disabilities, and elderly individuals with limited financial resources. Medicaid is jointly funded by the federal and state government. Medicaid programs vary
from state to state though there are some services that are required by the federal government. Optional services can be offered by each state
Managed Medicaid
plans typically require precert for SNF placement. Ask SNF referrals if in doubt. Precerts typically take 1-2 days, and expire within 48 hrs of approval, so plan precert initiation wisely!
PPO
A preferred provider organization is a type of health insurance arrangement that allows plan participants relative freedom to choose the doctors and hospitals they want to visit
Qualified Medicare Benificiary-Also
The QMB-Also program is for people who receive Part A Medicare and whose income is below 100 percent of poverty. This program pays Medicare co-payments and co-insurance amounts for medical services covered by Medicare, including the co-payments for Medicare-approved skilled nursing home care. It also pays the Medicare Part B premiums for eligible clients.
