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Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The main difference between the two programs is that Medicaid covers healthcare costs for people with low incomes while Medicare provides health coverage for the elderly. There are also dual health plans for people who have both Medicaid and Medicare. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."
Medigap refers to various private health insurance plans sold to supplement Medicare in the United States. Medigap insurance provides coverage for many of the co-pays and some of the co-insurance related to Medicare-covered hospital, skilled nursing facility, home health care, ambulance, durable medical equipment, and doctor charges. Medigap's name is derived from the notion that it exists to cover the difference or "gap" between the expenses reimbursed to providers by Medicare Parts A and B for the preceding named services and the total amount allowed to be charged for those services by the United States Centers for Medicare and Medicaid Services (CMS).
The Massachusetts health care reform, commonly referred to as Romneycare, was a healthcare reform law passed in 2006 and signed into law by Governor Mitt Romney with the aim of providing health insurance to nearly all of the residents of the Commonwealth of Massachusetts.
The California Medical Assistance Program is California's Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level. Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long term care and supports. Approximately 13.3 million people were enrolled in Medi-Cal as of January 2018, or about one-third of California's population; in Tulare County and Merced County, more than 50% of county residents were enrolled as of September 2015.
The Medicare Part D coverage gap is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment - consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached OR the current annual period lapses. In calculating whether the maximum amount of gap has been reached, the "True-out-of-pocket" costs (TROOP) are added together. "TrOOP includes the amount of your Initial Deductible and your co-payments or co-insurance during the Initial Coverage stage. While in the Donut Hole, it includes what you pay when you fill a prescription and of the 75% Donut Hole discount on brand-name drugs, it includes the 70% Donut Hole Discount paid by the drug manufacturer. The additional 5% Donut Hole discount on brand-name drugs and the 75% Donut Hole discount on generics do not count toward TrOOP as they are paid by your Medicare Part D plan."
Medicare Advantage is a type of health insurance plan in the United States that provides Medicare benefits through a private-sector health insurer. In a Medicare Advantage plan, a Medicare beneficiary pays a monthly premium to a private insurance company and receives coverage for inpatient hospital and outpatient services. Typically, the plan also includes prescription drug coverage. Many plans also offer additional benefits, such as dental coverage or gym memberships. By contrast, under so-called "Original Medicare", a Medicare beneficiary pays a monthly premium to the federal government and receives coverage for Part A and Part B services, but must purchase other coverage separately.
In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.
Members of the United States population between the ages of 18 and 29 who decide that it is in their financial best interest to forgo health insurance are sometimes referred to as young invincibles by the insurance industry, a term coined to express the idea that the young demographic perceives themselves as immune to sickness and injury. The argument is that these individuals are young and in good health, so they have a low risk of experiencing substantial health issues that would lead to large amounts of spending on health care. Further, this group tends to have a mentality of “it won’t happen to me” with regards to most causes of injury. Together, these beliefs lead to the young invincibles not purchasing insurance.
The Association for Community Affiliated Plans (ACAP) is a national trade association representing 78 nonprofit health plans. Headquartered in Washington, D.C., ACAP advocates on behalf of its community-affiliated member health plans operating throughout the United States. ACAP's advocacy work focuses on representing publicly sponsored programs and health care providers who serve vulnerable populations. ACAP also promotes universal access to quality and cost-efficient care.
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act, and colloquially known as Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.
Covered California is the health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance coverage at federally subsidized rates. It is administered by an independent agency of the government of California.
Washington Healthplanfinder is one of the fourteen health insurance marketplaces in the United States and was created in accordance with the Patient Protection and Affordable Care Act, commonly referred to as Obamacare.
Connect for Health Colorado is the health insurance marketplace, previously known as health insurance exchange, in the U.S. state of Colorado, created in accordance with the Patient Protection and Affordable Care Act. It is located in Denver. The marketplace operates a toll-free call center and offers 541 health plans from 18 insurance companies.
HealthCare.gov is a health insurance exchange website operated under the United States federal government under the provisions of the Affordable Care Act, which currently serves the residents of the U.S. states which have opted not to create their own state exchanges. The exchange facilitates the sale of private health insurance plans to residents of the United States and offers subsidies to those who earn between one and four times the federal poverty line, but not to those earning less than the federal poverty line. The website also assists those persons who are eligible to sign up for Medicaid, and has a separate marketplace for small businesses.
kynect, formerly and also called the Kentucky Health Benefit Exchange, is the health insurance marketplace, previously known as health insurance exchange, in the U.S. Commonwealth of Kentucky, created by then-Governor Steve Beshear in accordance with the Patient Protection and Affordable Care Act. Steve Beshear's successor as governor, Matt Bevin, ended Kynect enrollment for individuals as of 2017. From 2017-2020, the marketplace operated a web site for small business owners. Bevin's successor, Andy Beshear, announced on June 17, 2020 that Kentucky will reestablish a state health insurance marketplace similar to kynect, with full implementation by January 1, 2022. Kynect was officially relaunched on October 5, 2020 with full implementation expected by January 2022.
NY State of Health is the health insurance marketplace, previously known as health insurance exchange, in the U.S. state of New York, created in accordance with the Patient Protection and Affordable Care Act. The marketplace operates a website.
Patient navigators educate and assist United States citizens in enrolling into health benefit plans stipulated in the Patient Protection and Affordable Care Act (ACA). Patient navigators are also called "insurance navigators" or "in-person assisters" who have defined roles under the ACA. Although their roles might overlap, patient navigators are not community health workers or health advocates. "Navigators" work in states with Federally-Facilitated Exchanges (FFEs) or State Partnership Exchanges.
The federal Small Business Health Options Program is an insurance exchange, created by Patient Protection and Affordable Care Act (Obamacare). The Small Business Health Options Program (SHOP) Marketplace helps small businesses to provide health coverage to their employees. Therefore, it is open to employers with 50 or fewer full-time equivalent employees (FTEs), in which it also includes non-profit organizations.
Enhanced Direct Enrollment (EDE) is a provision in the United States that allows certain private entities, including insurance carriers and web-brokers, to directly enroll consumers in Qualified Health Plans through the Health Insurance Marketplace without redirecting consumers to Healthcare.gov. Approved EDE partners may access a suite of APIs which allow them to directly submit and update applications on the federal exchange.
GoHealth is a marketplace for Medicare plans including Medicare Advantage, MediGap and Medicare Part D, which are programs administered through private health insurance companies. It also operates an online health insurance marketplace offering individual health insurance and short-term health insurance.
References
- 1 2 "Maryland Health Benefit Exchange" . Retrieved October 7, 2013.
- ↑ "Report from the Maryland Health Benefit Exchange about Maryland Health Connection, the state based health insurance marketplace" (PDF). Baltimore: Maryland Health Benefit Exchange. 2019. Retrieved September 14, 2020.
- ↑ "Maryland Health Connection Launches Second Special Enrollment Period". Baltimore: WBAL NewsRadio. August 7, 2020. Retrieved September 14, 2020.
- ↑ "Need health insurance? Maryland reopened its health exchange due to the coronavirus again". Baltimore: Baltimore Sun. August 7, 2020. Retrieved September 14, 2020.
- ↑ Eichensehr, Morgan (November 20, 2017). "Maryland health exchange names new executive director". Baltimore Business Journal. Retrieved July 9, 2019.
