Podcast
Questions and Answers
What are commercial health policies?
What are commercial health policies?
- Policies that do not require monthly payments
- Policies that do not cover pre-paid health plans
- Policies that have no specific benefits assigned
- Policies where owners can assign benefits directly to the health care provider (correct)
What is capitation?
What is capitation?
Payment given to a physician for each HMO member
What is a gatekeeper system?
What is a gatekeeper system?
Subscribers select a care physician who handles everything
What is Medicare?
What is Medicare?
What is MEWA?
What is MEWA?
How is funding for Medicare Part B provided?
How is funding for Medicare Part B provided?
Who is Medicaid intended for?
Who is Medicaid intended for?
When a preferred provider organization (PPO) insured goes out-of-network, what happens?
When a preferred provider organization (PPO) insured goes out-of-network, what happens?
How much does Medicare Part B pay for physician fees?
How much does Medicare Part B pay for physician fees?
What is Medicare Part B also known as?
What is Medicare Part B also known as?
What was expanded when Medicaid was established?
What was expanded when Medicaid was established?
What does a doctor who accepts Medicare Assignment agree to?
What does a doctor who accepts Medicare Assignment agree to?
What must a medical provider that accepts Medicare Assignment do?
What must a medical provider that accepts Medicare Assignment do?
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Study Notes
Health Insurance Providers Overview
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Commercial Health Policies: Allows policy owners to assign benefits directly to healthcare providers; includes pre-paid health plans with specific benefits and monthly payments.
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Capitation: A fixed payment made to a physician for each member enrolled in a Health Maintenance Organization (HMO).
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Gate Keeper System: A system where subscribers select a primary care physician who manages all their healthcare needs.
Medicare Insights
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Medicare: Provides medical services for individuals aged 65 and older, those with chronic kidney disease, and recipients of Social Security Disability for at least 24 months. Covers hospital room and board, physician services, and prescription drugs.
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Medicare Part B Funding: Mostly funded by general tax revenue and user premiums, with 80% coverage for physician fees.
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Medicare Assignment: Physicians accepting Medicare Assignment agree to charge no more than the Medicare-approved amount for services, covering 80% of costs with beneficiaries responsible for 20% after the deductible.
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Supplementary Medical Insurance: Another name for Medicare Part B.
Medicaid and Employer Plans
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Medicaid: Designed to assist individuals in poverty, providing financial support for various health services.
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MEWA (Multiple Employer Welfare Arrangement): Allows small employers to sponsor group benefits for their employees through an insurer.
Preferred Provider Organizations (PPO)
- Out-of-Network Coverage: When PPO insured individuals seek care outside the network, their insurer pays a reduced amount for services rendered.
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