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Block 11; Week 4-M > Health Insurance > Flashcards

Flashcards in Health Insurance Deck (37)
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When did Blue Cross Blue Shield begin?

1930s & 1940s


When did government programs really expand to cover healthcare costs?

1950s & 1960s


When was the ACA signed into law?

March 23rd, 2010


What is happening w/ the ACA now?

still implementing into 2018
Congress & Health & Human Services are tweaking it
U.S. Supreme Ct is weighing in on it soon


What is the purpose of the ACA?

1. decrease # of uninsured (35% of pop.)
2. make health insurance available to everyone
3. provide gov't assistance when ppl can't afford health insurance (medicaid, SCHIP, exchanges/subsidies)
4. regulate health insurers on how private plans are offered (min. benefits, no pre-existing limitations)


Which public programs do we have today?

SCHIP-Nevada Check up
Federal & State Exchanges


Which private programs do we have today?

Federal and State Exchanges
Private individual policies
Private group policies


What are the private market positives?

Variety of options
Plan designs, provide networks, insurance companies
Competitive forces lead to better service and quality
Providers are generally compensated better > appointments easier to obtain, less waiting
Possible subsidies on the Exchange for lower income
Tax favored premiums for employers and employees


What are the private market negatives?

Can be very expensive for individuals and employers
Generally premiums are $400/month for individual $1000/month for a family
Plan designs and max out of pocket are cost prohibitive
$6600 Annually for an individual
$13,200 Annually for a family
Market place can be difficult to navigate
Compliance is very challenging. Employers > 50 employees MUST offer health insurance or face steep penalties
Premiums are not tax favored for individuals


What is fee for service? What are the requirements?

health coverage that reimburses health providers for their services
most costly for employers
no PCP, network, or referral required


What is an HMO?

health maintenance organization
covers services performed solely by providers in a network
this tends to be a low cost system, but is more restrictive than other plans
requires PCP & referrals
Can't be covered for out of network


What is a PPO?

preferred provider organization
network of providers, allows use of medical providers outside of the plan's network
referrals may be required
more flexible, but more expensive


What is a high deductible health plan?

paired w/ a tax-advantaged account to pay medical expenses
like a health reimbursement arrangements, health savings accounts
high deductible
no referral, PCP required


What is a health savings account?

tax-advantaged account used to pay for qualified medical expenses
used in conjunction w/ HDHP
funds remaining in account at end of plan year are rolled over into account for next year
PCP, network, referral not required


What is a point-of-service plan?

sorta HMO + PPO
more benefits if stay in network & begin w/ PCP
require PCP, network, referrals


What is a health reimbursement arrangement?

program that allows employers to set aside an amount of funds to reimburse participating employees for medical expenses.
often combined w/ another health plan
**may not require PCP, may not require network or referral


What is the health flex spending account?

account set up thru a health plan that allows employees to contribute funds that are not subject to payroll tax.
unused funds are lost after a grace period.
can carry over $500 unused funds
may not need network, PCP, referral


What is a health savings account?

**Can put money away on pre-tax basis, have high deductible, savings account
tax-advantaged account used to pay for qualified medical expenses
used in conjunction w/ HDHP
funds remaining in account at end of plan year are rolled over into account for next year
PCP, network, referral not required


Once again, what are the public insurance options?

Nevada Medicaid
Nevada Check-Up (SCHIP)


What are the self-pay options for uninsured?

Access to Healthcare Network Medical Discount Program
Women’s Health Connection
Nevada Colorectal Cancer Control Program
Community Programs – Safety Net


What is NV medicaid?

Funded by both the federal government and state government
Administered by the state government – rates, benefits, etc.
Expanded in 2013-2014 by the Affordable Care Act
Regular Medicaid vs. emergency Medicaid
Application Process


Who is eligible for nevada medicaid?

Live between 0 – 138% of the FPL
Pregnant and lives between 0-165% of the FPL
US Citizen or Legal Resident (more than 5 years)


What are the benefits of Medicaid?

Reduced the number of uninsured and Uncompensated care
No cost access to care
Preventive services, Specialty care services, Hospital services


WHat are issues w/ medicaid?

Reimbursement rates
Lack of providers/services
Member/patient policies – No call/no show rates, Patient Termination
Not available to everyone


What is nevada checkup? Eligibility?

Medicaid for children
Low cost access to care
Similar issues as Medicaid

Live between 0 – 205% of the FPL
US Citizen, Legal resident (more than 5 years)


What is medicare?

Health Insurance for Seniors and the Disabled
Administered by Federal government
Largest single payer source
Types of Medicare
Medicare and healthcare innovation


Who is eligible for medicare?

65 and Older
US Citizen, Legal resident
Paid into Social Security/Medicare


What are the benefits of medicare?

Safety Net for seniors and the disabled
Relatively low administrative costs
Driving healthcare innovation – business opportunity


What are the issues w/ medicare?

High cost of premiums and care
Not available to everyone
Reimbursement rates
Medicare Fee schedule fix


Who is eligible for medicare?

65 and Older (have to be paying into system for 7 years)
US Citizen, Legal resident
Paid into Social Security/Medicare