POL

Suppose your health plan covers lab tests in full if you go to an in-network lab, but only pays 60% of allowed charges if you go out of network. You forgot to check and go get your blood test at a lab that turns out to be out of network. The lab bills you $100 for the blood test. Your health insurance allows only a $20 charge for that test. How much would you have to pay out of pocket for that lab test?

$88

Of nearly 63 million people served by Medicaid each year, approximately how many are children?

1/2

Approximately what share of the federal budget goes toward Medicare, the federal program that provides health insurance to elderly and disabled Americans across all income levels?

15%

Suppose that under your health insurance policy, hospital expenses are subject to a $1,000 deductible and $250 per day copay. You get sick and are hospitalized for 4 days, and the bill (after insurance discounts are applied) comes to $6,000. How much of that hospital bill will you have to pay yourself?

2,000

Approximately what percent of Medicaid spending goes toward children?

20%

Half of all Medicare beneficiaries lived on incomes of less than what amount in 2013, including income from Social Security and all other sources?

26200

What share of the total Medicare population is enrolled in a Medicare Advantage plan, such as a Medicare HMO or PPO, rather than the traditional Medicare program?

30%

The approximate percentage of cost of care an insurance plan will cover is called:

Actuarial value

Now that the ACA coverage provisions are in effect, who becomes newly eligible for Medicaid in the states adopting the Medicaid expansion?

Adults below 138% of the FPL.

Which group accounts for most Medicaid spending?

Elderly & disabled

If you receive inpatient care at a hospital that participates in your health plan's provider network, all the doctors who care for you while you're in the hospital will also be in network.

False

Medicaid is available to everyone over 65 years of age regardless of income.

False

Plans differ on the amount of actuarial value they have; plans with higher actuarial value cost less.

False

he Patient Protection and Affordable Care Act has no impact on Medicaid.

False

Medicaid is funded by:

Fed and state gov

Blue Cross, founded in 1929, helped individuals purchase:

Hospital Services

Which of the following services is not typically covered by Medicare?

Long-term care services and supports, such as a nursing home stay Preventive services, such as mammograms and prostate cancer screening

Medicaid covers:

Low income children and families People with developmental and physical disabilities Low income nursing home residents

Medicaid reimbursements rates are usually ________ reimbursements rates paid by Medicare and private insurance.

Lower than

What pays for most long term care?

Medicaid

What types of assistance does Medicaid provide for Medicare beneficiaries?

Medicaid pays for Medicare premiums and copays for low-income beneficiaries. Medicaid pays for healthcare services not covered by Medicare, such as home and community-based services.

How does the recent growth in Medicaid spending per person compare to the growth in private health insurance premiums per person?

Medicaid spending grew slower than private health insurance premiums.

is Medicare spending expected to grow faster or slower per person than private health insurance spending over the next decade?

Medicare spending is expected to grow SLOWER than private health insurance spending on a per person basis.

The federal government has mandated legal minimums for Medicaid including:

Minimum access to care Minimum eligibility requirements Minimum medical service requirements

Is a health insurance premium something you must pay every month, regardless of whether you use health care services, or do you only have to pay your health insurance premium during months when you use health care services?

Must pay every month, regardless of whether you use services.

Do all Medicare beneficiaries pay the same premium for coverage of physician and outpatient services, regardless of their income?

No, not all Medicare beneficiaries pay the same premium.

Traditional Medicaid covers:

Pregnant women up to 133% of FPL. The elderly and those with disabilities who receive SSI Kids under 6 years of age up to 133% FPL

Employer sponsored insurance usually covers:

Preventive services Pharmaceuticals Care if you get sick

In the states not expanding Medicaid, non-elderly adults below 100% of the federal poverty line will likely:

Remain uninsured and continue to face access and financial barriers to care.

Which of the following is the best definition of the term "health insurance premium"?

The amount health insurance companies charge each month for coverage.

Which of the following is the best definition of the term "annual health insurance deductible"?

The amount of covered health care expenses you must pay yourself each year before your insurance will begin to pay.

Which of the following best describes a health plan "provider network"?

The hospitals and doctors that contract with your health plan to provide services for an agreed-upon rate or fee schedule.

Which of the following best describes a "health insurance formulary"?

The list of prescription drugs your health plan will cover.

Which of the following best describes the "annual out-of-pocket limit" under a health insurance policy?

The most you will have to pay in deductibles, copays, and coinsurance for covered care received in network for the year.

Medicaid is a U.S. healthcare program that finances the care of low income and certain high-risk populations.

True

The Medicaid expansion population will be paid at 100% by the federal government for calendar years 2014 through 2016.

True

There remains great flexibility from one state to another in how Medicaid programs are administered.

True

Medicare Part ______ is similar to health insurance that covers you against hospitalization due to catastrophic events.

a

Approximately what percent of Americans receive health insurance coverage through Medicaid at some point during the year?

about 20%

_____ is a defined percentage of medical costs the insured must pay after the deductible has been met.

co-insurance

The set fees you have to pay every time you access the healthcare system are called:

copay

____ is the amount of money you are responsible for paying after the premium but before the insurance begins to pay for treatment.

deductible

About 60% of US Citizens get health insurance from:

employer

About 70% of hospitals are nonprofit organizations in the public sector.

false

Medicaid is administered at the federal level.

false

The Medicaid program is the same in all states.

false

Under current law, how soon is Medicare's Hospital Insurance Trust Fund projected to become insolvent, meaning it will not have enough money to pay the full cost of beneficiaries' hospital care?

in the next 10-15 years

__________ are doctors or hospitals with whom insurance companies have negotiated lower rates.

network

Most large employer health plans protect enrollees from extraordinary high medical bills by placing an annual limit on out-of-pocket costs. Does the traditional Medicare program do that?

no

Medicare Part ____ is an opportunity for private companies to offer Medicare-like benefits as an alternative to other Medicare benefits.

part C

Although nearly 2/3 of people get their insurance from private companies, only about 1/3 of spending comes from the private sector.

true

Employer sponsored insurance became more common during WWII when employers, restricted by wage controls, started competing for workers by offering them benefits like health insurance.

true

If your health insurance or health plan refuses to pay for a service that you think is covered and your doctor says you need, you can appeal the denial and possibly get the insurance company to pay the claim.

true

Medigap policies are Medicare supplemental insurance policies offered by private companies that often cover the copays or coinsurance.

true

More expensive plans usually have lower deductibles while less expensive plans usually have higher deductibles.

true

Does the health reform law close the Medicare prescription drug benefit's "doughnut hole", or coverage gap, so seniors no longer have to pay the full cost of their medications when they reach the gap?

yes