Ch. 3-Government-Sponsored Healthcare Programs Flashcards
Children’s Health Insurance Program (CHIP)
A state-federal partnership created by the Balanced Budget Act of 1997 that provides health insurance to children of families whose income level is too high to qualify for Medicaid but too low to purchase healthcare insurance
Chronic conditions special needs program (C-SNP)
A form of Medicare Advantage plan for Medicare beneficiaries with severe disabling chronic conditions such as heart failure, diabetes mellitus, end-stage liver disease, and dementia
Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
A benefits program administered by the Department of Veterans Affairs for the spouse or widow(er) and children of a veteran who meets specified criteria
Coverage gap
Period of expanded cost sharing based on prescription drug utilization and cost experienced by beneficiaries enrolled in Medicare Part D
Dual eligible special needs program (D-SNP)
A form of Medicare Advantage plan for Medicare beneficiaries who qualify for both Medicare and Medicaid
Federal Employees’ Compensation Act of 1916 (FECA)
A benefit program that ensures that civilian employees of the federal government are provided medical, death, and income benefits for work-related injuries and illnesses
Indian Health Service (IHS)
An agency within the Department of Health and Human Services (HHS) responsible for upholding the federal government’s obligation to promote healthy American Indian and Alaskan Native people, communities, and cultures
Institutional special needs program (I-SNP)
A form of Medicare Advantage plan for Medicare beneficiaries who live in an institution like a nursing home or who require nursing care at home
Medicaid
Part of the Social Security Act, a joint program between state and federal governments to provide healthcare benefits to low-income persons and families
Medicare
Federally funded healthcare benefits program for those persons 65 and older, as well as for this entitled to Social Security benefits
Medicare Advantage (MA)
Optional managed care plan for Medicare beneficiaries who are entitled to Part A, are enrolled in Part B, and live in an area with a plan
Types of plans include HMO, PPO, POS plan, and provider-sponsored organization
Medicare Part A
The portion of Medicare that provides benefits for inpatient hospital services
Medicare Part B
An optional and supplemental portion of Medicare that provides benefits for physician services, medical services, and medical supplies not covered by Medicare Part A
Medicare Part C
A managed care option that includes services under Parts A, B, and D and additional services that are not typically covered by Medicare; requires an additional premium
AKA Medicare Advantage
Medicare Part D
Medicare drug benefit created by the Medicare Modernization Act of 2003 (MMA) that offers outpatient drug coverage to beneficiaries for an additional premium
