US Healthcare System

Question 1

Government funded programs

Answer 1

Medicare, Medicaid, Children’s Health Insurance program (CHIP), Department of Defense TRICARE, Indian Health Services, Veteran’s Health Administration

Question 2

Medicare

Answer 2

Seniors 65+, people with disabilities, patients with End-Stage renal disease

Question 3

Medicare Part A

Answer 3

Hospital Insurance: nursing facilities, hospice care, home health care

Question 4

Medicare Part B

Answer 4

Medical insurance: outpatient care, preventive care, med supplies

Question 5

Medicare Part C

Answer 5

Medicare Advantage Plans (MA Plans): A, B, D are bundled by private commercial insurer. May include visual, dental, hearing

Question 6

Medicare Part D

Answer 6

Prescription meds

Question 7

Medicaid

Answer 7

For people with limited income

Question 8

CHIP

Answer 8

For children/teens of families who do not qualify for Medicaid but cannot afford private insurance. Financed by both federal gov and states

Question 9

Department of defense TRICARE

Answer 9

For active duty personnel, retirees, and families. Care provided through military treatment facilities (MTFs).

Question 10

Indian health services (IHS)

Answer 10

Agency of the department of health and human services. Provide services to American Indian and Alaskan native tribes.

Question 11

Veteran health administration (VHA)

Answer 11

Operated by department of Veterans Affairs. Provides care for US military veterans. Only uses facilities owned by the government and healthcare providers are paid with a Federal. No requirement of payment of premium or deductibles only copayments.

Question 12

Private insurance

Answer 12

Partially subsidized by employers or purchased individually

Question 13

Health savings account (HSA)

Answer 13

Savings account that allows a person to save money for medical expenses. Provides tax benefits.

Question 14

Managed care plans

Answer 14

Health maintenance organizations (HMO), preferred provider organization (PPO), point of service (POS), exclusive provider organization (EPO)

Question 15

Health maintenance organization (HMO)

Answer 15

Patient must have a primary care physician who is first point of contact referral is needed

Question 16

Preferred provider organization (PPO)

Answer 16

And Rollies are not required to choose a PCP and do not need a referral to see a provider outside of the PPO net work. Usually more expensive

Question 17

Point of service (POS)

Answer 17

Hybrid between PPO and HMO must have in network PCP but easier and slightly more expensive to go out of network for healthcare services

Question 18

Exclusive provider organization (EPO)

Answer 18

Hybrid plan. Only can receive healthcare services from exclusive network of providers. However, no referral is needed from PCP to visit a specialist but specialist must be with an exclusive net work

Question 19

Patient protection and affordable care act (PPACA) of 2010

Answer 19

Obama care. Healthcare insurance affordable to more people. Requires all uninsured individuals to purchase at least a basic form of healthcare.

Question 20

Insurance exchanges

Answer 20

Also known as market place. Established by some state governments, as well as federal government to hop individuals find appropriate entrance plans only accept applications during open enrollment.

Question 21

Healthcare for undocumented immigrants

Answer 21

Student health plans, employer-sponsored coverage, individual plans, purchased off exchange

Question 22

The emergency medical treatment in active labor act (EMTALA)

Answer 22

Requires hospitals to screen and stabilize anyone that comes into the emergency room, regardless of insurance or immigration status

Question 23

Worker’s Compensation

Answer 23

Insurance that employers have to ensure that an injured employee gets medical attention and compensation, and protects the business from being sued by the employer