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Health Policy > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What are the 2 broad categories of health disparities?

A

health STATUS disparities
health CARE disparities

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2
Q

Which health disparity encompass disparities in health care access, quality, and outcomes?

A

health CARE disparities

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3
Q

Which health disparity does the following define?:
“differences that occur by gender, race or ethnicity, education or income, disability, living in rural localities or sexual orientation”

A

STATUS

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4
Q

Which health disparity does the following define?:
“differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the united States. Research on health disparities related to socioeconomic status is also encompassed in the definition”

A

STATUS

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5
Q

Which health disparity does the following define?:
“racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of interventions”

A

CARE

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6
Q

What are the 3 measurement categories of health?

A

structural
process
outcome

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7
Q

What is considered a difference in healthcare delivery?

A

clinical indications and patient preferences

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8
Q

What is considered a disparity in healthcare delivery?

A

systemic factors such as resources or access and biases, stereotyping, and uncertainty

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9
Q

______ is a tool to advance public health as well as define and enforce rights and responsibilities within the healthcare and public health systems.

A

law

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10
Q

What is a situation in which everyone has the opportunity to attain his or her full health potential?

A

health equity

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11
Q

What part of medicare is for hospital/inpatient services?

A

part A

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12
Q

What part of medicare is for physician/outpatient services?

A

part B

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13
Q

What part of medicare is for managed care plans (Medicare Advantage)?

A

part C

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14
Q

What part of medicare is for prescription drug plans?

A

part D

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15
Q

Which part(s) of Medicare has mandatory enrollment?

A

part A

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16
Q

Which part(s) of Medicare has voluntary enrollment?

A

parts B, C, D

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17
Q

Which part(s) of Medicare is financed through a mandatory 2.9% payroll tax?

A

A

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18
Q

Which part(s) of Medicare is financed through a general federal tax revenue?

A

B

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19
Q

Which part(s) of Medicare is financed through annual deductibles?

A

B and D

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20
Q

Which part(s) of Medicare is financed through parts A, B, and D?

A

C

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21
Q

Which part(s) of Medicare is financed through monthly premiums?

A

B and D

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22
Q

Which part(s) of Medicare is financed through deductibles for each day of in-patient stay?

A

A

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23
Q

Which part(s) of Medicare is financed through hospital care after 60 days and skilled nursing facility care after 20 days?

A

A

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24
Q

Which part(s) of Medicare is financed by Medicare paying the insurance company a capitated rate for covering the beneficiary?

A

C

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25
Q

Which part(s) of Medicare has a complicated cost-sharing structure that is known as the “doughnut hole”?

A

D

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26
Q

Which part(s) of Medicare is financed through a sliding scale of a small additional premium if income is more than $85,000/$170,000?

A

D

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27
Q

Which part(s) of Medicare provides some subsidies to help with premium and cost-sharing for those with incomes under 150% FPL with modest assets.

A

D

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28
Q

What is Medigap?

A

Supplemental insurance

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29
Q

Why would someone choose to have Medigap?

A

to cover out-of-pocket costs not covered by A and B

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30
Q

Does Medigap give you access to additional services or coverage?

A

no

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31
Q

Is Medigap a federally regulated plan?

A

yes

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32
Q

What is meany by “dual eligibles”?

A

When Medicaid helps pay for Medicare’s premiums and cost sharing for Medicare beneficiaries with low income and modest assets.

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33
Q

What does MACRA stand for?

A

Medicare Access and CHIP Reauthorization Act

34
Q

What prohibits Medicare supplemental insurance (Medigap) policies from covering the Part B deductible for people who become eligible for Medicare on or after January 1, 2020?

A

MACRA of 2015

35
Q

Why was MACRA of 2015 put into place?

A

due to Moral Hazard

36
Q

Which part(s) of Medicare provides comprehensive coverage that usually includes prescriptions?

A

C

37
Q

Which part(s) of Medicare limits out-of-pocket spending?

A

C

38
Q

Can you have both Medigap and Medicare Advantage?

A

no

39
Q

Those enrolled in which parts of Medicare can also enroll in Medigap?

A

A and B

40
Q

What are some services that are not covered under Medicare?

A

vision
dental
hearing aids/hearing exams
nursing homes

41
Q

Why might an individual select traditional Medicare over Medicare Advantage?

A

traditional Medicare does not vary based on geographic location

42
Q

3 main “pathways” to Medicare eligibility.

A
  • over 65 AND qualify for SS benefits
  • disability: must qualify for SS Disability Income AND have been collecting benefits for 24 months
  • diagnoses of ESRD, ALS, and receiving SSDI payments
43
Q

To received Medicare eligibility, do you need to be a U.S. citizen or legal resident?

A

yes

44
Q

Is long-term care covered with Medicare Part A?

A

no

45
Q

There is a 10% __________ for each year a person is eligible but not enrolled in Part B.

A

penalty

46
Q

Is Medicare free for the beneficiary?

A

no

47
Q

Why might someone choose to have Medicare Advantage over traditional Medicare?

A

MA has more benefits, it it comprehensive coverage, and it allows you to budget.

48
Q

How are nursing homes paid for in the US?

A

through Medicaid

49
Q

What type of purchasing is the Medicare Reimbursement Policy moving toward?

A

value-based purchasing

50
Q

What does it mean for Medicaid to be an entitlement program?

A

that the government is supposed to provide benefits to a certain population

51
Q

How many low-income Americans does Medicaid cover?

A

1 in 5

52
Q

As enacted, the ACA Medicaid expansion would cover adults up to ___% FPL in all states, filling long-standing gaps in coverage.

A

138

53
Q

What is an exception to Medicaid coverage?

A

undocumented residents are not covered and states are not required to cover legal residents during first 5 years in the US.

54
Q

What group of people does the federal government match funds for under Medicare?

A

pregnant women and children who are legal immigrants with less than 5 years of residency

55
Q

What does EPSDT stand for?

A

early
periodic
screening
diagnosis
treatment

56
Q

__________ benefits reflect the needs of the population that it serves.

A

Medicaid

57
Q

What percentage of Medicaid spending is for long-term care?

A

40%

58
Q

What are eligible individuals entitled to with Medicare?

A

a defined set of benefits

59
Q

What are states entitled to under Medicare?

A

the federal government matching funds

60
Q

What is the federal governments role under the federal-state partnership through Medicaid?

A

to set core requirements on eligibility and benefits

61
Q

What is the states role under the federal-state partnership through Medicaid?

A

states have the flexibility to administer the program within federal guidelines

62
Q

What percentage does the federal government pay for Medicaid?

A

57%

63
Q

What percentage of the states budget does Medicaid take up?

A

17-20%

64
Q

CHIP covers children under what age?

A

19 y/o

65
Q

Is CHIP or Medicaid a more flexible program

A

CHIP

66
Q

CHIP takes care of some of the gaps in what insurance plan?

A

Medicaid

67
Q

Can children covered by CHIP be eligible for Medicaid?

A

no

68
Q

Is CHIP an entitlement program?

A

no

69
Q

Are the benefits for CHIP more or less defined than for Medicaid?

A

less

70
Q

Is dental a required benefit for CHIP?

A

yes

71
Q

________ has a higher FMAP called EFMAP.

A

CHIP

72
Q

What population does CHIP try to cover?

A

the near poor

73
Q

What are 3 reasons why states like CHIP?

A
  • high match by the federal government
  • flexibility that it provides in coverage
  • ability to charge premiums
74
Q

What are the 3 parts of the CHIP Congressional Intent?

A
  • reduce the number of uninsured children
  • build on Medicaid but not as an entitlement
  • gives states flexibility
75
Q

How does the enrollment and spending of CHIP compare to Medicaid?

A

much less

76
Q

What services are optional with CHIP but not with Medicaid?

A

vision and hearing

77
Q

What 3 things are federal funds allotted to states based on?

A
  • recent CHIP spending
  • adjusted annually for child population growth
  • medical inflation
78
Q

How many years does states have to spend each allotment for CHIP?

A

2

79
Q

For CHIP, states that use allotted funds and exceed target enrollment are also eligible for what?

A

contingency fund payments

80
Q

For CHIP, the federal government provides matching funds like Medicaid but federal funds are __________ for each state.

A

capped

81
Q

There is reduced matching from the federal government for CHIP for covering children over ___% FPL

A

300

82
Q

What are the top 2 reasons why families enroll their children in CHIP?

A

affordability
health care need

Health Policy (3 decks)

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