Navigate PBC Alliance Meeting 8/16/13
Jeopardy Game Questions and Answers
Let’s Start With the Basics
100 A.The federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs, and the federally facilitated Marketplace
Q. What is Centers for Medicaid and Medicare Services (CMS)?
200A. The year the Patient Protection and Affordable Care Act and the Health Care and Education and Reconciliation Act were signed into law, and the president who signed the Acts into law.
Q. What is 2010? Who is President Barack Obama?
300A. The date the Health Insurance Marketplace opens.
Q. What is October 1, 2013?
400A. If you live in Florida, you’ll use this website, to apply for coverage, compare plans, and enroll in coverage through the Health Insurance Marketplace.
Q. What is healthcare.gov?
500A. Under the Affordable Care Act, starting in 2014, this is an insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-picket maximum amounts), and meets other requirements.
Q. What is Qualified Health Plan?
Coverage – It’s Important
100A. The earliest date coverage applied for through the Health Insurance Marketplace will be available.
Q. What is January 1, 2014?
200A. The Marketplace insurance plans fall into these 4 health plan categories based on how you and the plan can expect to share the costs of care.
Q. What are platinum, gold, silver and bronze?
300A. The comprehensive package of items and services the Affordable Care Act ensures that health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, will include.
Q. What are essential health benefits?
400A. If you do not have coverage that is considered minimum essential coverage starting January 2014, you may have to pay this.
Q. What is a penalty fee?
500A. Under the ACA, parents can keep children on their health insurance policy until they turn this age.
Q. What is age 26?
The Changes are a’Comin’
100A. Soon, under the ACA, you cannot be denied health coverage for having this- a health problem you had before the date that new health coverage starts.
Q. What is a pre-existing condition?
200A. Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
Q. What are preventive services?
300A. A change in your life such as: moving to a new state, changes in your income, and changes in your family size (for example, if you marry, divorce, have a baby, or become pregnant) that can make you eligible for a Special Enrollment Period to enroll in health coverage.
Q. What is a qualifying life event?
400A. Under the ACA, a rule prevents health plans from requiring higher copayments or co-insurance for out-of-network visits to this part of the hospital.
Q. What is the emergency room / emergency department?
500A. These are three of the services that fall under the Essential Health Benefits – items or services that, at a minimum, all private health insurance plans in the Marketplace must offer.
Q. What are: - Ambulatory patient services (outpatient care you get without being admitted to a hospital) – Emergency services – Hospitalization – Maternity and newborn care (care before and after your baby is born) – Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) – Prescription drugs – Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) – Laboratory services – Preventive and wellness services and chronic disease management – Pediatric services
Money Matters
100A. A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.
Q. What is a copayment?
200A. Insurance companies will no longer be able to implement this which would cap the amount they spend on essential health benefits for your care during the entire time you’re enrolled in that plan.
Q. What is a lifetime limit?
300A. This policy requires insurance companies to spend your premium dollars primarily on health care and improving its quality. If your insurance company exceeds that limit, it must provide a rebate of the portion of premium dollars.
Q. What is the 80/20 rule?
400A. Beginning in 2014, individuals and families with incomes between 100% and 400% of FPL who purchase coverage through a health exchange are eligible for these.
Q. What are tax credits? [Individuals and families with incomes up to 250% FPL may also be eligible for cost-sharing (e.g. coverage with lower deductibles and copayments)].
500A. The figure used to determine eligibility for lower costs in the Marketplace and for Medicaid and CHIP. Generally, this is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have.
Q. What is Modified Adjusted Gross Income (MAGI)?
Potpourri
100A. In addition to a QHP, the Marketplace will also tell individuals if they are eligible for these programs.
Q. What are Medicaid and the Children’s Health Insurance Plan (KidCare)?
200A. Under the ACA, states were able to expand this program in exchange for financial incentives. Florida is among the states that have opted not to expand.
Q. What is Medicaid?
300A. The resource that provides assistance 24 hours a day in 150 languages regarding the Marketplace and come October 1st will offer assistance with application completion and plan selection.
Q. What is the Marketplace Call Center? (1-800-318-2596)
400A. Dental coverage for children is an essential health benefit. This means it must be available to you either as part of a health plan or as a free-standing plan. (True or False)
Q. What is True? (This is not the case for adults. Insurers don’t have to offer adult dental coverage).
500A. A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services.
Q. What is guaranteed issue?