Medicaid and Medicare Flashcards

1
Q

Who does Medicaid cover?

A

the low income population of the US

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2
Q

How is Medicaid financed?

A

both through the government and states (matching rates); collected through payroll taxes from working people

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3
Q

Entitlement program

A

means tested; based on income relative to the federal poverty level

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4
Q

Who covers nursing home costs?

A

Medicaid

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5
Q

Who have the highest Medicaid expenditures?

A

the disabled and blind populations

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6
Q

Federal Medicaid Assistance Program (FMAP)

A

how much the federal government matches spending the state; takes into account income per capita within states; minimum is 50% and max is 77%

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7
Q

Federal poverty line (FPL)

A

the line the government considers to be within poverty

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8
Q

Federal mandate

A

to receive federal funding states must cover certain populations

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9
Q

Who do states have to cover through Medicaid?

A

low income: pregnant people, children <6, children 6-18, parents and caretakers, people with disabilities, etc

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10
Q

What is Medicaid expansion?

A

states had the option to “opt in” to increase eligibility of adults, received 100% matching rate for newly covered population

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11
Q

Minimum eligibility standards for states who expanded Medicaid

A

138% for pregnant people, children, adults, and parents

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12
Q

Medically needy

A

too much money to qualify but spending significant money on medical care

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13
Q

Challenges of Medicaid

A

costs (long term care coverage is expensive), challenges to expansion in court

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14
Q

Maintenance of effort (MOE)

A

maintained Medicaid coverage for anyone on Medicaid while the public health emergency is in effect

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15
Q

SCHIP/CHIP

A

created in 1997, extends health insurance for children whose families earn too much to qualify for Medicaid but who cannot afford private insurance

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16
Q

Medicare

A

created in 1965, covers the population that is over 65, on disability payments, etc

17
Q

Is Medicare means tested?

A

no

18
Q

Dual eligible

A

people eligible for both Medicare and Medicaid, Medicare is the main form of insurance, automatically enrolled in Part D

19
Q

What are the parts of Medicare?

A

Part A, Part B, Part C, Part D

20
Q

Medicare Part A

A

covers inpatient hospital services, everyone is automatically enrolled in Part A

21
Q

How is Medicare Part A financed?

A

Medicare payroll tax, no premiums but there are deductibles and coinsurance

22
Q

Medicare Part B

A

covers physician expenditures and outpatient hospital costs, will not be enrolled in both B and C

23
Q

How is Medicare Part B financed?

A

enrollee premiums and general government revenue from income taxes

24
Q

What are the specific costs of Medicare Part B?

A

premium: $164.90 increase is income above $91k; deductible: $226; coinsurance: 20%

25
Q

Medicare Part C

A

Medicare Advantage, a way of opting into preventative care but through a private company rather than the govt

26
Q

Medicare Part D

A

Prescription drug bill, premium and deductible

27
Q

Services not covered by Medicare

A

long term care services, dental care, eye care, hearing aids/exams

28
Q

Medigap program

A

can opt in, covers the “coverage gap” where certain services aren’t covered

29
Q

Challenges to Medicare

A

complex system, solvency, no long term care provisions

30
Q

Why pick Part B (not C)?

A

fee for service model, coverage across US anywhere that takes Medicare

31
Q

Why pick Part C (not B)?

A

may be easier to use, can include services covered in Part A and D

32
Q

How does Part C Medicare work?

A

not fee for service, have HMOs/PPOs with limited networks to choose between, different cost sharing options

33
Q

Changes to Medicare

A

lowered cost of Part B, all vaccines covered at no cost, policies around insulin with no deductible, negotiation for prescription drugs