US Healthcare/ Insurance System Flashcards
What makes one eligible for ACA? Affordable care act
Coverage of children, in some states adults, to at least 133% of the FPL
How is one eligible for premium subsidies?
They must be <400% of the FPL
(138- 400%)
What is the purpose of ACA
It’s an attempt at universal healthcare in US fully implemented in 2014 which funded public health measures
What is MediCARE?
a FEDERALLY funded insurance program for people aged 65 and over and for those who qualify for social security due to disability or End stage renal disease
Medicare Part A
Hospital insurance
*Years of medicare taxes paid determines premium
Medicare Part B
Medicare insurance, everyone pays a premium
Physician and nursing services (Office visits) & preventative care, diagnostic studies
*Premium (based on income) must be paid for yearly visits after starting plan
Medicare Part C
Medicare Advantage Plans
Private insurance
Medicare Part D
Drug Coverage
Medicare Advantage Prescription Drug plan must join a private insurance plan
MedicAID
State managed supported by federal and state funds but state regulated/ mandated
Provides insurance for LOW INCOME individuals of ALL ages
What is income based of for MedicAID
Income level is based on GROSS annual income as well as the number of people in your household
What else is included in MedicAID?
CHIP (Children’s heath insurance program)
covers children who do not meet the eligibility for medicaid and children who do quality for medicaid can enroll in CHIP
What are Mandatory eligibility groups for MedicAID
Low income families
Qualified pregnant women and children
Persons who receive supplemental security income
What makes an individual eligible for MedicAID?
Their estimated income must be at least 138% in most states
Characteristics of the Uninsured
The working poor are most likely to be uninsured
These individuals don’t make enough and don’t have employers that provide them with insurance plans
When calculating for the amount owed by a patient on a hospital bill, which order should the calculation take place?
Deductible then co-insurance
