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us healthcare final > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

what are the 2 dimensions of universal healthcare?
which did obamacare attempt to achieve?

A

-everyone is covered
-everyone is guaranteed free services of healthcare

obamacare attempted to get everyone covered

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2
Q

true or false

there are people still uninsured even after obamacare

A

true – 15-20 million are still uninsured

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3
Q

WHY are there still 15-20 million americans uninsured even after the passage of obamacare?

A

the individual mandate no longer exists – was deemed unconstitutional by the supreme court

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4
Q

true or false

insurers do not have to offer different levels of coverage for preexisting conditions

A

FALSE – they do. this is because of ACA

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5
Q

are all private insurances regulated by the states?

A

before 2010, yes. obamacare made some private plans federal

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6
Q

what are “preexisting conditions”

A

conditions that existed before changing jobs/insurance

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7
Q

what was the transitional stop gap insurance before 2010?

A

COBRA

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8
Q

Explain what COBRA is

A

guarantees EXACT SAME insurance coverage for those who have lost their job health coverage and are out of insurance for a LIMITED period of time

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9
Q

as mentioned, COBRA is a transitional insurance that offers the same health coverage for a LIMITED time. how long is this time period?

A

18-36 months

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10
Q

what is the downside of COBRA

A

it is temporary

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11
Q

what is the major benefit of COBRA?

A

not only do you get insurance in a transitional period, but it is the EXACT SAME coverage as before

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12
Q

are pre-existing conditions covered under COBRA

A

yes — you get the exact same benefits

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13
Q

what kind of people is COBRA available to?

A

there is a limit – the previous business place of employment must have had a certain number of employees in the last year (20)

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14
Q

differentiate between the premium ratings

A

experience rating and community rating

experience = dependent on health status. if you use healthcare more, it is a higher premium

community = uses GROUP rating

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15
Q

most group insurance plans use experience rating or community rating to determine premiums?

A

community rating

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16
Q

obamacare was an attempt at healthcare that is not ____, but ____

A

not FREE, but universal

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17
Q

name 2 major upsides of what obamacare accomplished

A
  1. coverage for preexisting conditions
  2. subsidized healthcare purchases (MEDICAID EXPANSION)
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18
Q

what does it mean that Obamacare “subsidizes healthcare purchases”

A

programs like CHIP and medicaid – financial grants. not everyone qualifies for it – only certain populations

19
Q

For states with EXPANDED MEDICAID, what is the requirement to qualify

A

must be 138% below the FPL (federal poverty level)

20
Q

as mentioned, for states with expanded medicaid, to qualify they must be 138% below the federal poverty level

is this a state guideline or a federal guideline?

A

FEDERAL

21
Q

Was obamacare designed for public or private health insurance? which is it geared more towards?

A

BOTH
geared more towards private

22
Q

explain how obamacare is geared more towards private insurance

A

-the way it reforms healthcare delivery in the private sector

23
Q

is obamacare geared more towards medicare or medicaid?

A

medicaid

24
Q

_____ has ACO’s

A

medicare

25
Q

how many states have expanded medicaid coverage?

A

41

26
Q

what happens to people who do not have insurance but do not meet the requirements for their state medicaid program?

A

obamacare’s federal poverty level usually is low enough for them to qualify

27
Q

which is bigger – ACA or COBRA

A

ACA

28
Q

Name 3 ways in which obamacare subsidizes healthcare

A

-medicaid/CHIP
-reduced medicare reimbursements to healthcare providers under medicare advantage
-premium tax credits – depend on a person’s income – lowers their monthly insurance payments

29
Q

who started open enrollment? what does this mean?

A

obamacare
a time period once a year 4-5 weeks when people can purchase/revise their health insurance benefits.

(last chance for coverage by jan 1 is dec 15)

30
Q

what are “marketplace plans”

A

obamacare plasn

31
Q

what is a big upside that obamacare has over cobra

A

they have the 10 essential benefits – not guaranteed under COBRA

32
Q

Can employer sponsered-plans be better than obamacare

A

yes – could also be worseq

33
Q

true or false

mental health/substance use disorder is part of the 10 essential benefits of marketplace plans

A

TRUE

34
Q

explain “emergency services” under the 10 essential marketplace benefits

A

you can get care from the closest hospital. no penalties for going to out of network hospital

35
Q

true or false

pregnancy is considered the #1 preexisting condition

A

FALSE – it used to be, but its not even considered a preexisting condition at all anymore

36
Q

rehab services and devices are a category of _____ care, and are not conventionally considered ___ care

A

custodial care, not medical care

37
Q

true or false

custodial care is not conventionally considered medical care, bc it is provided by non-licensed caregivers

A

true

38
Q

obamacare offers catastrophic plans. explain what this is

A

designed for people who can’t afford normal plans

has very low monthly premiums but high deductibles

39
Q

of the 4 “metal” plans, which has the highest premium? which has the highest deductibles? which has the LOWEST deductibles?

A

platinum – highest premiums but lowest deductibles (cost of care)

bronze – highest deductibles but lowest premiums

40
Q

true or false

premium and deductible costs are directly proportional

A

false — inverse
as one goes up, the other goes down

41
Q

name the 4 types of marketplace plans

A

EPO – exclusive provider organization
HMO – health maintenance organization
POS – point of service plans
PPO – preferred provider organization

42
Q

between the 4 types of marketplace plans, which is the most expensive?

A

PPO – preferred provider organization

43
Q

between the 4 types of marketplace plans, which offers the LEAST access to facilities and networks? which offers the most access?

A

least access (most restrictive) = HMO
most access (least restrictive) = PPO

44
Q
A

us healthcare final (9 decks)

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