Health Insurance

    Results: 6

  • Health Insurance Information/Counseling (3)
    LH-3500

    Health Insurance Information/Counseling

    LH-3500

    Programs that offer information and guidance for people who need assistance in selecting appropriate health insurance coverage and which may also answer questions about health insurance benefits and help people complete insurance forms.
  • Health Insurance/Dental Coverage (1)
    LH-3000

    Health Insurance/Dental Coverage

    LH-3000

    Organizations that issue insurance policies which reimburse policy holders for all or a portion of the cost of hospital, medical or dental care or lost income arising from an illness or injury.
  • Medicaid (7)
    NL-5000.5000

    Medicaid

    NL-5000.5000

    A combined federal and state program administered by the state that provides medical benefits for individuals and families with limited incomes who fit into an eligibility group that is recognized by federal and state law. Each state sets its own guidelines regarding eligibility and services within parameters established at the federal level. Many people are covered by Medicaid, though within these groups, certain additional requirements must be met. Eligibility factors include people's age, whether they are pregnant, have a disability, are blind, or aged; their income and resources (like bank accounts, real property or other items that can be sold for cash); and whether they are U.S. citizens or lawfully admitted immigrants. Families who are receiving benefits through TANF and individuals who receive SSI as aged, blind and disabled are categorically eligible groups. The rules for counting a person's income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes, for people served under the Medicaid Waiver program, for people served by Program of All-Inclusive Care for the Elderly (PACE) programs and for children with disabilities living at home. Medicaid makes payments directly to a person's health care provider; and some recipients may be asked to pay a small part of the cost (co-payment) for some medical services. Most states have additional "state-only" programs to provide medical assistance for specified low-income persons who do not qualify for the Medicaid program.
  • Medicare (1)
    NS-8000.5000

    Medicare

    NS-8000.5000

    A federally funded health insurance program administered by the Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), for people age 65 and older; for individuals with disabilities younger than age 65 who have received Social Security Disability benefits for at least 24 consecutive months; and for insured workers and their dependents who have end stage renal disease and need dialysis or a kidney transplant. Premiums, deductibles, and co-payments or out-of-pocket costs are required for Medicare coverage. Special programs that assist with paying some or all of these costs are available for low income persons who qualify. Medicare has four parts: Hospital Insurance (Part A), which helps pay for care in a hospital or skilled nursing facility, home health care and hospice care; Supplemental Medical Insurance (Part B), which helps pay for doctors, outpatient hospital care and other medical services including the Medicare Preventive benefits (effective January 1, 2005); Medicare Advantage (Part C, formerly known as Medicare+Choice), which offers a variety of Medicare managed care options, including coordinated care plans and private, unrestricted fee-for-service plans, that are required to provide, at minimum, the same benefits as Part A and B, excluding hospice services; and the Medicare Prescription Drug Benefit (Part D, effective January 1, 2006), a program managed by private plans that assists in covering the cost of prescription drugs for beneficiaries. People who have Medicare Part A and/or Part B need to join a Medicare prescription drug program to obtain insurance coverage for prescription drugs.
  • Medicare Quality Improvement Organizations (1)
    DF-6500.5100

    Medicare Quality Improvement Organizations

    DF-6500.5100

    Groups of practicing health care providers who are paid by the federal government to generally oversee the care provided to Medicare beneficiaries in each state and to improve the quality of services.
  • PACE Programs (1)
    NL-5000.6800

    PACE Programs

    NL-5000.6800

    A capitated benefit authorized by the Balanced Budget Act of 1997 (BBA) that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than being institutionalized. Capitated financing allows providers to deliver all services participants need rather than being limited to those reimbursable under the Medicare and Medicaid fee-for-service systems. The BBA established the PACE model of care as a permanent entity within the Medicare program and enables States to provide PACE services to Medicaid beneficiaries as a State option. The State plan must include PACE as an optional Medicaid benefit before it can enter into program agreements with PACE providers. Participants must be at least 55 years of age, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant's needs. The care is overseen by an interdisciplinary team, consisting of professional and paraprofessional staff.
 
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