MEDICARE/MEDICAID QUIZ WITH 59
QUESTIONS AND CORRECT
ANSWERS RATED A+
medicaid overview
- state system WITH federal support
- covers services for low-income, families and children, preg women, the elderly,
people with disabilities
- benefits differ from state to state
- covered services usually included in dr visits, hospital care, vaccinations,
prescription drugs, vision, hearing, LTC, preventative care, and some therapies
and community care as well as DME
- ortho and derm often refuse
preferred provider organization (PPO)
- patient chooses provider and services
- insurer pays provider for services
- provider decides what and how much care, and cost for service
- premiums may be higher than HMO
- pre-determined discounted fee-for-service
- can go outside of network for services
health maintenance organization (HMO)
- access to certain physicians and hosp w/in network
- preventative medicine, pick PCP
- must use providers within HMO
- generally have lower premium
exclusive provider organization (EPO)
- patient chooses provider and services (similar to HMO)
- usually less expensive than PPO
- no referral needed for specialist
, - limited doctors and hosp in network to choose from
- if outside network, all costs paid out of pocket
private pay
- most common method 1st half of 20th century
- needs vs luxury
fee for service
unit of payment for each visit or procedure
fee for service with utilization review
traditional payment with the 3rd party payer assuming power to authorize or
deny payment for certain expensive interventions
episode of illness
one sum for services during one illness (diagnosis-related groups drgs)
episodic
one sum for a specific period of time
per diem payment
payment for all services delivered for one day
capitation
a specified amount of money paid to a health plan or doctor, usually on a monthly
basis, for each member of a health plan, regardless of the amount of service
received
affordable care act (ACA)
- also called obama care
- legally called patient protection and affordable care act
goals of ACA
- increase quality and affordability of health insurance
- lowering uninsured rate by expanding public and private insurance coverage
QUESTIONS AND CORRECT
ANSWERS RATED A+
medicaid overview
- state system WITH federal support
- covers services for low-income, families and children, preg women, the elderly,
people with disabilities
- benefits differ from state to state
- covered services usually included in dr visits, hospital care, vaccinations,
prescription drugs, vision, hearing, LTC, preventative care, and some therapies
and community care as well as DME
- ortho and derm often refuse
preferred provider organization (PPO)
- patient chooses provider and services
- insurer pays provider for services
- provider decides what and how much care, and cost for service
- premiums may be higher than HMO
- pre-determined discounted fee-for-service
- can go outside of network for services
health maintenance organization (HMO)
- access to certain physicians and hosp w/in network
- preventative medicine, pick PCP
- must use providers within HMO
- generally have lower premium
exclusive provider organization (EPO)
- patient chooses provider and services (similar to HMO)
- usually less expensive than PPO
- no referral needed for specialist
, - limited doctors and hosp in network to choose from
- if outside network, all costs paid out of pocket
private pay
- most common method 1st half of 20th century
- needs vs luxury
fee for service
unit of payment for each visit or procedure
fee for service with utilization review
traditional payment with the 3rd party payer assuming power to authorize or
deny payment for certain expensive interventions
episode of illness
one sum for services during one illness (diagnosis-related groups drgs)
episodic
one sum for a specific period of time
per diem payment
payment for all services delivered for one day
capitation
a specified amount of money paid to a health plan or doctor, usually on a monthly
basis, for each member of a health plan, regardless of the amount of service
received
affordable care act (ACA)
- also called obama care
- legally called patient protection and affordable care act
goals of ACA
- increase quality and affordability of health insurance
- lowering uninsured rate by expanding public and private insurance coverage
