Question

An enrollee in a PPO plan receives a service out-of-network. What will the PPO plan use to determine payments to the out-of-network provider? A prospective payment Usual, customary, and reasonable (UCR) fee schedule Geo-Access Mapping Cost-sharing tiers

Gail has an income of 80% of the federal poverty level (FPL). She lives in the State of Florida, and is a childless adult. Given this information, which of the following statements is true? Gail will fall into the insurance coverage gap

None of the answers are correct

Gail will be eligible for Medicaid

Gail is eligible for a premium subsidy on the health insurance exchange

Answer 1

Answer :

PPO plan :

Prefered provider organization plans through this we can meet the network physician, with out requiring referral form primary care physician.

PPO plans are used to provide energy and urgent medical care services, if it is not emergency or urgent it will not cover the cost of health care, we need to provide all costs for health care in out of network provider.

Q. No. 2. Answer :

Gail will eligible for medicaid,

Because income of 100% to 400% of federal powerty level people are having eligible for premium subsidy on health insurance exchange.

Here the Gail having income of 80 % only.

So Gail will eligible for medicaid.