Lecture 3 Flashcards
what are the 2 dimensions of universal healthcare?
which did obamacare attempt to achieve?
-everyone is covered
-everyone is guaranteed free services of healthcare
obamacare attempted to get everyone covered
true or false
there are people still uninsured even after obamacare
true – 15-20 million are still uninsured
WHY are there still 15-20 million americans uninsured even after the passage of obamacare?
the individual mandate no longer exists – was deemed unconstitutional by the supreme court
true or false
insurers do not have to offer different levels of coverage for preexisting conditions
FALSE – they do. this is because of ACA
are all private insurances regulated by the states?
before 2010, yes. obamacare made some private plans federal
what are “preexisting conditions”
conditions that existed before changing jobs/insurance
what was the transitional stop gap insurance before 2010?
COBRA
Explain what COBRA is
guarantees EXACT SAME insurance coverage for those who have lost their job health coverage and are out of insurance for a LIMITED period of time
as mentioned, COBRA is a transitional insurance that offers the same health coverage for a LIMITED time. how long is this time period?
18-36 months
what is the downside of COBRA
it is temporary
what is the major benefit of COBRA?
not only do you get insurance in a transitional period, but it is the EXACT SAME coverage as before
are pre-existing conditions covered under COBRA
yes — you get the exact same benefits
what kind of people is COBRA available to?
there is a limit – the previous business place of employment must have had a certain number of employees in the last year (20)
differentiate between the premium ratings
experience rating and community rating
experience = dependent on health status. if you use healthcare more, it is a higher premium
community = uses GROUP rating
most group insurance plans use experience rating or community rating to determine premiums?
community rating
obamacare was an attempt at healthcare that is not ____, but ____
not FREE, but universal
name 2 major upsides of what obamacare accomplished
- coverage for preexisting conditions
- subsidized healthcare purchases (MEDICAID EXPANSION)
what does it mean that Obamacare “subsidizes healthcare purchases”
programs like CHIP and medicaid – financial grants. not everyone qualifies for it – only certain populations
For states with EXPANDED MEDICAID, what is the requirement to qualify
must be 138% below the FPL (federal poverty level)
as mentioned, for states with expanded medicaid, to qualify they must be 138% below the federal poverty level
is this a state guideline or a federal guideline?
FEDERAL
Was obamacare designed for public or private health insurance? which is it geared more towards?
BOTH
geared more towards private
explain how obamacare is geared more towards private insurance
-the way it reforms healthcare delivery in the private sector
is obamacare geared more towards medicare or medicaid?
medicaid
_____ has ACO’s
medicare
how many states have expanded medicaid coverage?
41
what happens to people who do not have insurance but do not meet the requirements for their state medicaid program?
obamacare’s federal poverty level usually is low enough for them to qualify
which is bigger – ACA or COBRA
ACA
Name 3 ways in which obamacare subsidizes healthcare
-medicaid/CHIP
-reduced medicare reimbursements to healthcare providers under medicare advantage
-premium tax credits – depend on a person’s income – lowers their monthly insurance payments
who started open enrollment? what does this mean?
obamacare
a time period once a year 4-5 weeks when people can purchase/revise their health insurance benefits.
(last chance for coverage by jan 1 is dec 15)
what are “marketplace plans”
obamacare plasn
what is a big upside that obamacare has over cobra
they have the 10 essential benefits – not guaranteed under COBRA
Can employer sponsered-plans be better than obamacare
yes – could also be worseq
true or false
mental health/substance use disorder is part of the 10 essential benefits of marketplace plans
TRUE
explain “emergency services” under the 10 essential marketplace benefits
you can get care from the closest hospital. no penalties for going to out of network hospital
true or false
pregnancy is considered the #1 preexisting condition
FALSE – it used to be, but its not even considered a preexisting condition at all anymore
rehab services and devices are a category of _____ care, and are not conventionally considered ___ care
custodial care, not medical care
true or false
custodial care is not conventionally considered medical care, bc it is provided by non-licensed caregivers
true
obamacare offers catastrophic plans. explain what this is
designed for people who can’t afford normal plans
has very low monthly premiums but high deductibles
of the 4 “metal” plans, which has the highest premium? which has the highest deductibles? which has the LOWEST deductibles?
platinum – highest premiums but lowest deductibles (cost of care)
bronze – highest deductibles but lowest premiums
true or false
premium and deductible costs are directly proportional
false — inverse
as one goes up, the other goes down
name the 4 types of marketplace plans
EPO – exclusive provider organization
HMO – health maintenance organization
POS – point of service plans
PPO – preferred provider organization
between the 4 types of marketplace plans, which is the most expensive?
PPO – preferred provider organization
between the 4 types of marketplace plans, which offers the LEAST access to facilities and networks? which offers the most access?
least access (most restrictive) = HMO
most access (least restrictive) = PPO
