healthcare continue

Medicare Part A

Inpatient hospital care insurance established in 1965 that is basically free of monthly premiums for most seniors, covering hospital stays, skilled nursing facility care, home health care, and hospice (00:08:27-00:09:45, Slide 1, KFF Medicare Primer Page 1).

Medicare Part B

Supplementary medical insurance established in 1966 covering physician visits, outpatient hospital care, and preventive services, requiring a monthly premium scaled by individual income ($185 per month for incomes up to $106,000) (00:10:02-00:12:58, Slide 1, Slide 2, KFF Medicare Primer Page 1).

Medicare Part C (Medicare Advantage)

Managed care alternative (HMO or PPO) enacted under the Balanced Budget Act of 1997 that allows beneficiaries to receive Parts A and B (and usually Part D) benefits through private plans contracted with Medicare (00:11:42-00:11:56, Slide 1, KFF Medicare Primer Page 1, Page 3).

Medicare Part D

Voluntary outpatient prescription drug benefit established by the Medicare Modernization Act of 2003 and launched in 2006, delivered through private stand-alone plans or Medicare Advantage plans (00:11:56-00:12:35, Slide 1, KFF Medicare Primer Page 1, Page 3).

Medicaid (Medi-Cal in California)

Joint federal-state public health insurance program established in 1965 delivering health coverage to low-income welfare recipients, pregnant individuals, children, elderly, blind, and disabled populations with minimal out-of-pocket costs (00:16:47-00:19:45, Slide 3, KFF Medicaid Pocket Primer Page 1).

Children's Health Insurance Program (CHIP)

Federal-state public coverage program created in 1997 (66% federal / 33% state funding) for uninsured children in families with incomes too high for standard Medicaid, folded into Medi-Cal in California in 2013 (00:26:39-00:27:54, Slide 4, Slide 5).

Affordable Care Act Individual Mandate

Federal healthcare provision taking effect in 2014 requiring nearly all U.S. citizens to maintain government-defined minimum essential health coverage or pay a tax penalty (00:28:25-00:28:34, Slide 6, Slide 7, YouToons Video 0:30-1:00).

Medicaid Expansion under the ACA

Expansion mechanism allowing states to extend Medicaid eligibility to nonelderly adults earning up to 138% of the federal poverty level, backed by a federal matching rate of at least 90 percent (00:21:29-00:22:06, 00:32:46-00:33:18, Slide 9, KFF Medicaid Pocket Primer Page 1).

ACA Health Insurance Exchanges (Marketplaces / Covered California)

Transparent mega-mall platforms established under the ACA where individuals and small businesses can shop for private health plans and receive income-based government tax credit subsidies (00:28:51-00:30:02, Slide 7, YouToons Video 1:30-2:15).

ACA Dependent Coverage Extension to Age 26

Federal insurance regulation allowing young adults to remain covered under their parents' employer-sponsored or individual health plans until reaching age 26 (00:30:26-00:30:50, Slide 8, YouToons Video 2:00-2:15).

ACA Pre-Existing Condition Protection

Federal insurance rule prohibiting health plans from denying coverage, cancelling policies, or charging higher premiums based on an applicant's pre-existing health conditions (00:31:32-00:31:48, Slide 8, YouToons Video 2:00-2:15).

Medical Loss Ratio (80/20 Rule under ACA)

Affordable Care Act mandate requiring private health insurers to spend at least 80 percent of premium revenue directly on patient clinical care and quality improvement or issue rebates to policyholders ($2.4 billion refunded through 2016) (00:31:48, Slide 8, KFF Medicare Primer Page 4).

Medicare Benefit Period

A unit of time measuring Part A hospital stay utilization that begins the day a patient enters a hospital or skilled nursing facility and ends after 60 consecutive days without inpatient care (KFF Medicare Primer Page 8).

Medicare Part D Coverage Gap ("Doughnut Hole")

A drug benefit phase where beneficiaries pay a higher percentage of prescription drug costs out-of-pocket after initial coverage limits until reaching catastrophic threshold spending (KFF Medicare Primer Page 4).

Medigap (Medicare Supplemental Insurance)

Private insurance policies (Plans A through N) purchased by beneficiaries in traditional Medicare to pay out-of-pocket deductibles, copayments, and coinsurance costs (KFF Medicare Primer Page 2, Page 9).

Federal Medical Assistance Percentage (FMAP)

The statutory federal matching formula determining the share of state Medicaid spending paid by the federal government, ranging from 50% to 75% for standard populations (KFF Medicaid Pocket Primer Page 1).

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)

Comprehensive mandatory pediatric benefit under Medicaid providing complete preventive, developmental, and medical care for children (KFF Medicaid Pocket Primer Page 2).

Medicaid Section 1115 Waivers

Federal authorization granting states flexibility to test innovative healthcare delivery, eligibility, and payment models that diverge from standard federal Medicaid rules (KFF Medicaid Pocket Primer Page 1).

Dual-Eligible Beneficiaries

Individuals enrolled in both Medicare and Medicaid who receive primary coverage through Medicare while Medicaid pays Medicare premiums, cost-sharing, and non-covered services like long-term nursing care (KFF Medicare Primer Page 2, Page 6).

Medicare Savings Programs (MSPs)

State-administered Medicaid programs (such as QMB, SLMB, and QI) that pay Medicare Part A and B premiums and cost-sharing for low-income seniors who do not qualify for full Medicaid (KFF Medicare Primer Page 2, Page 7).

Government Poverty Reduction Rationale for Public Insurance

The professor's historical and economic context explaining that the federal government established Medicare and Medicaid in 1965 as antipoverty measures to prevent elderly and low-income individuals from depleting life savings on healthcare (00:07:44-00:08:13).

Medi-Cal Income Thresholds for 2026

California's specific Medicaid eligibility cutoff levels based on federal poverty limits: nonelderly adults at or below 138% FPL ($15,960 for an individual in 2026), children at or below 266% FPL, and pregnant individuals at or below 213% FPL (00:21:41-00:22:14).

NFIB v. Sebelius Supreme Court Ruling (2012)

The 2012 Supreme Court ruling holding that the ACA mandatory Medicaid expansion was unconstitutionally coercive, making expansion optional for individual state governors and legislatures (00:32:46-00:33:18, Slide 9, YouToons Video 1:00-1:20).

Medicaid Coverage Gap in Non-Expansion States

The policy gap in non-expansion states where low-income adults earning below 100% FPL earn too much for state Medicaid cutoff but too little to qualify for ACA marketplace tax subsidies (00:32:46-00:33:18, YouToons Video 1:00-1:20).

Medi-Cal Coverage History for Undocumented Immigrants

California's policy history extending Medi-Cal coverage options to undocumented residents, which expanded historically but faced shifting state political options and funding limits (00:57:02-00:57:36).

Catastrophic Health Plans under ACA

Low-budget, high-deductible coverage options available on ACA marketplaces specifically restricted to adults under age 30 or individuals experiencing financial hardship (YouToons Video 2:00-2:15).

What is the financial funding structure for Medicare versus Medicaid?

{Medicare is funded 100 percent by the federal government with 0 percent state contribution, giving federal CMS complete operational authority, whereas Medicaid is jointly financed by federal matching funds and state funds and operated by individual states (00:08:40-00:08:51, 00:19:03-00:19:16, Slide 1, Slide 3).

How many total Americans were insured under public coverage by 2025/2026?

Medicare covers approximately 68 million individuals (60 million aged 65+ and 8 million younger disabled), while Medicaid covers 77 million people—representing 20 percent of all Americans, 40 percent of children, and 60 percent of nursing home residents (00:18:47-00:19:03, Slide 1, Slide 3).

What ACA provision requires employers with 50 or more employees to cover full-time workers?

Under the ACA employer mandate, businesses with 50 or more full-time staff must offer affordable health insurance to full-time workers or pay a tax penalty (YouToons Video 0:45-1:00, Slide 7).