FMHC - Government Funded Programs
What are the eligibility requirements for Medicaid?
100% of Federal Poverty Level or less than 138% FPL in some states *based on Modified Adjusted Gross Income (MAGI) Fed govn and state
How many Americans does the government cover in health insurance?
35% or 112 million people Medicare (43 M) Medicaid (62 M)
What are the eligibility requirements for Medicare?
Adults over age of 65, people with disabilities, and those with end stage renal disease (ERSD) and ALS Fed govn
Which program potentially covers nursing home assistance?
Medicaid (with restriction)
What are the parts of Medicare?
Part A: inpatient hospital care, skilled nursing services, hospice care (no monthly premiums) Part B: dr visits, outpatient hospital services, physician administered drugs, etc (additional monthly premium) Part C: advantage plans, maybe dental, vision, hearing (offered through private insurance) Part D: prescription drug coverage (additional monthly premium)
Explain the "donut hole" in Medicare prescription coverage
Stage 3 of Part D of Medicare requires plan members to pay the full cost of medications minus 75% discounts for brand name and generic drugs. This coverage gap is a very large out-of-pocket expense and is based on tiers of drug classes.
What are the primary differences between the Veterans Health Administration, Military Health System, and Tricare?
Veterans Health Administration (VHA): ran by department of veterans affairs, lifetime benefits if enrolled 5 years post-combat or fall into a specialty veteran category, works hand-in-hand with most insurance providers Military Health System: active-duty personnel through DOD Tricare: families of active-duty or retired military personnel; paid by government but uses private doctors and hospitals All fed govn.
Is medicaid free for those that qualify?
Yes, for the most part.
What is the primary purpose of the Indian Health Service (IHS)?
addresses unique social, cultural, and health needs of Native American people -Delivers services to 2.6 M Indians and Alaska Natives -Covers 574 tribes in 37 states, and include dental, and behavioral healthcare
what does Medicaid cover?
dr visits, hospital procedures and stays, preventative medicine, pregnancy care, home health, long-term health
do you have to be 65 plus to qualify for Medicare?
no
is medicare free for those that qualify?
no
describe the primary purpose of Children's Health Insurance Program
provides low-cost to no-cost health services to qualified children up to the age of 19 Designed for families who do not qualify for Medicaid, but have incomes generally below 200% FPL CHIP covers 8.9 M children in working families who ear too much to qualify for Medicaid but cannot afford or access private coverage
