Indiana Navigator Exam Questions & Answer

Medicare Part A - Answer Hospital Insurance Medicare Part B` - Answer Medical Insurance (out pt, Mental health services, ambulance, clinical research, premium requred Medicare Part C - Answer Medicare Advantage Plus (includes A and B) Replaces traditional medicare Medicare Part D - Answer Prescription drug coverage Qualified Medicare Beneficiary - Answer Pays part A and B premiums, deductibles, and co-insurance (Can be combined w Medicaid) Specified low income beneficiary - Answer Pays part B premium (can be combined w Medicaid) Qualified Individual - Answer Pays part B premium (CANT be combined w Medicaid) QMB only - Answer only Medicare, must meet income requirements (covers premiums, co-pay, and co-insurance) QMB also - Answer displays Medicaid traditional, pays for service that is not covered by Medicare Combined w Medicaid (covers premiums, co-pays, and deductibles) Coinsurance - Answer % a pt pays for a covered healthcare service after their deductible has been met. (most pt have 80/20) Copay - Answer fixed amount a pt pays for a covered healthcare service before their deductible has been met CoreMMIS - Answer Core Medicaid Management Information System used to verify IHCP eligibility Deductible - Answer amount paid out-of-pocket by the policy holder before an insurance provider will cover any healthcare expenses End Stage Renal Disease - Answer last stage of chronic kidney disease. pt will be on dialysis or need a kidney transplant to stay alive Emergency Medical Treatment and Lbaor Act - Answer requires anyone coming to the ER to be stabilized and treated regardless of their insurance status or ability to pay Fee-For-Service - Answer Payment model where healthcare services are bundled and paid for seperately Federal Poverty Levl - Answer Measure of income by the federal government to determine ipt eligibility for subsidized insurance plans Federally Qualified Health Center - Answer Community based healthcare providers that receive funds from the HRSA health Center Program to provide primary care services in underserved areas Group Health Plan - Answer GHP Employee plan maintained by an employer that provides Medicare care for employees and dependents through insurance Indiana Health Coverage Program - Answer IHCP Provides a healthcare safety net to Hoosier Children, aged, disabled, pregnant women and other eligible populations Inmate Presumptive Eligibility - Answer temporary coverage for approved inpatient admissions and services rendered during their admittance In- network - Answer Providers or healthcare facilities apart of a health plans network of providers Managed Care Entity - Answer Entities contracted with the state to administer individuals health insurance Medically Frail - Answer Refers to an individual w chronic health conditions Medically Necessary - Answer Services or supplies need to prevent, diagnose or treat an illness or condition that meets the accepted standards of medicine Out-Of-Network - Answer Healthcare that is not contracted w an individuals health insurance. Normally results in higher out-of-pocket expenses Primary Payors - Answer Insurance plan that pays first on a claim when a pt has more than one insurance plan RID numbers - Answer A 12-digit recipient identification number found on Medicaid cards (# never chnages)