Module 5 Vocab

Question 1

Activities of Daily Living (ADLs)

Answer 1

Activities of Daily Living are the functions that are required for daily living, if they cannot be performed then they will qualify for longterm care benefits.
(1) Dressing
(2) Transferring
(3) Toileting
(4) Eating
(5) Bathing
(6) Maintaining continence (Controlling bowel moevements)

Question 2

Affordable Care Act

Answer 2

Designed to make affordable coverage available for those who don’t have access to health insurance through their employer. There are 5 different coverage levels:
(1) Bronze - 60% of costs
(2) Silver - 70% of costs
(3) Gold - 80% of costs
(4) Platinum - 90% of costs
(5) Catastrophic coverage - high deductible

Question 3

Benefit period

Answer 3

Begins the first day the person receives Medicare-covered service and ends when the person has been out of service for 60 days. If the person is readmitted to the hospital after 60 days, they will begin a new benefit period and are required to pay a new deductible.

Question 4

Coinsurance

Answer 4

The percentage of the expenses that is paid by the insurance company once the deductible has been met for covered services. For Medicare, this is the percentage of the Medicare-approved amount that the beneficiary is responsible for paying.

Question 5

Conservator

Answer 5

A fiduciary appointed by the court to manage the financial affairs of an incompetent person.

Question 6

Copayment

Answer 6

A set amount that the insured will pay for a service as a doctor visit. This copay may or may not be applied to the annual deductible or coinsurance percentage (depending on the plan).

Question 7

Deductible

Answer 7

The amount of expense a beneficiary must first incur before Medicare begins payment for covered services. (Cost sharing)

Question 8

Durable Power of Attorney for Health Care (DPOAHC)

Answer 8

A document executed by a person called the principal, authorizing a person called the attorney in fact or agent to perform certain acts on behalf of the principal relating to medial matters.

Question 9

Health Maintenance Organizations (HMOs)

Answer 9

Provide comprehensive service benefits, with an emphasis on preventative care. Care is typically provided through physicians and facilities that contract with the organization.

Question 10

Health Savings Account

Answer 10

Tax-exempt trust available to individuals who purchase a plan that qualifies as high deductible. You can contribute ($3,850 individually or $7,750 for families each year) You can save an extra $1k if you are over the age of 55.

Question 11

Living Will

Answer 11

A document signed by a competent person statin their wishes health care wish (what should and should not be done) if they are incompetent in a terminal situation. This only applies to terminal situations, otherwise it is up to the Durable Power of Attorney for Health Care (DPOAHC)

Question 12

Long-term Care (LTC) Insurance

Answer 12

Provides overage for various custodial care expenses in the event the insured person becomes incapacitated as defined by the policy

Question 13

Long-term care rider

Answer 13

An optional attachment for some life insurance and annuities that offer long term care coverage if the person becomes incapacitated.

Question 14

Maximum Out-of-Pocket (MOOP) limit

Answer 14

A set maximum amount that the insured could have to pay, then the insurance must cover the entire amount left. It is a stop-loss that allows the insured to know the most they may have to pay.

Question 15

Medicare Advantage (Part C)

Answer 15

Provides 4 basic plan types:
(1) Medicare HMO
(2) Medicare PPO
(3) Medicare Private Fee for Service (PFFS)
(4) Medicare special needs plans

Question 16

Medicare HMO

Answer 16

With exception of emergency or urgent care, Medicare HMO patients must receive care through HMO-contracted doctors and hospitals.

Question 17

Medicare PPO

Answer 17

Generally, provides many of the same services of an HMO, but with few restrictions. PPO plans typically dot require you to choose a primary physician and services can be received from any provider.

Question 18

Medicare Private Fee for Services (PFFS)

Answer 18

Offered by private insurance companies, working with the Medicare system. Coverage may or may not be available in a particular area. Participants can receive care from any Medicare-approved doctor as long as they accept the terms of the plans payment. The insurance company decides the amount the participant pays.

Question 19

Medicare Special Needs Plans

Answer 19

Specifically targeted for people living in nursing homes or who live at home and require the same level of care provided in a nursing home. Participants must meet both Medicare and Medicaid eligibility and have a chronic or disabling disease.

Question 20

Medicap Policies

Answer 20

Sometimes sold to Medicare users by a private company, this is insurance that is intended to supplement Medcare coverage and reduce out-of-pocket costs when care is needed.