Matching questions
1-63 of 63
Click a definition to match it with a term
Managed Care - Common Structures *make sticky note
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- Health Maintenance Organization (HMO)
a. Pays providers a salary or capitation
b. Beneficiaries may only use in-network providers
c. HMO coordinates and controls receipt of services
- Preferred Provider Organization (PPO)
a. Pays provider on a discounted fee schedule
b. Beneficiary may use in- or out-of-network providers
- Point of Service Plans (POS)
, a. Combines features of HMO and PPO
b. Pays providers with capitation or other risk-sharing arrangement
c. Has a provider network; beneficiaries may use out-of-network provider
for designated services
d. Has a gatekeeper to control and coordinate care
Employer-based health insurance
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- Private
- Insurance that is purchased by employers for their employees and
financed through employer or joining employer-employee contributions
Medicaid: Financing
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- Medicaid is jointly financed by the federal and state governments
- Matching system
a. Federal Medical Assistance Percentage determines the matching rate;
rate is tied to each state's per capita income with poorer states receiving a
higher federal match, and must be at least 50/50
- The basis of the state and federal partnership is governed by the federal
medical assistance percentage (FMAP)
- Federal government guarantees federal match funds to states for
qualifying Medicaid expenditures
Medicare...
Give this one a try later!
, Medicaid Dual-eligible beneficiaries
A Brief History of the Rise of Health Insurance in the U.S.
Give this one a try later!
- 1929 - Blue Cross established its first hospital insurance plan at Baylor
University
- 1939 - Blue Shield began
- 1954 - IRS declared that employers could pay health insurance premiums
for their employees with pre-tax dollars
a. Contributed to shape the employer-based system of health insurance
- 1965 - Medicaid and Medicare were created
- 1970s - Health care cost up
Medicare Advantage (MA) by private insurance companies (MCO)
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- The beneficiaries receive both Part A and Part B services + Part D +
additional benefits
- Medicare pays a fixed amount per beneficiary to the companies offering
MA
- In many cases, MA beneficiaries need to use health care providers who
are in the plan's network
Individual mandate
Give this one a try later!
1-63 of 63
Click a definition to match it with a term
Managed Care - Common Structures *make sticky note
Give this one a try later!
- Health Maintenance Organization (HMO)
a. Pays providers a salary or capitation
b. Beneficiaries may only use in-network providers
c. HMO coordinates and controls receipt of services
- Preferred Provider Organization (PPO)
a. Pays provider on a discounted fee schedule
b. Beneficiary may use in- or out-of-network providers
- Point of Service Plans (POS)
, a. Combines features of HMO and PPO
b. Pays providers with capitation or other risk-sharing arrangement
c. Has a provider network; beneficiaries may use out-of-network provider
for designated services
d. Has a gatekeeper to control and coordinate care
Employer-based health insurance
Give this one a try later!
- Private
- Insurance that is purchased by employers for their employees and
financed through employer or joining employer-employee contributions
Medicaid: Financing
Give this one a try later!
- Medicaid is jointly financed by the federal and state governments
- Matching system
a. Federal Medical Assistance Percentage determines the matching rate;
rate is tied to each state's per capita income with poorer states receiving a
higher federal match, and must be at least 50/50
- The basis of the state and federal partnership is governed by the federal
medical assistance percentage (FMAP)
- Federal government guarantees federal match funds to states for
qualifying Medicaid expenditures
Medicare...
Give this one a try later!
, Medicaid Dual-eligible beneficiaries
A Brief History of the Rise of Health Insurance in the U.S.
Give this one a try later!
- 1929 - Blue Cross established its first hospital insurance plan at Baylor
University
- 1939 - Blue Shield began
- 1954 - IRS declared that employers could pay health insurance premiums
for their employees with pre-tax dollars
a. Contributed to shape the employer-based system of health insurance
- 1965 - Medicaid and Medicare were created
- 1970s - Health care cost up
Medicare Advantage (MA) by private insurance companies (MCO)
Give this one a try later!
- The beneficiaries receive both Part A and Part B services + Part D +
additional benefits
- Medicare pays a fixed amount per beneficiary to the companies offering
MA
- In many cases, MA beneficiaries need to use health care providers who
are in the plan's network
Individual mandate
Give this one a try later!
