Differentiate between the different funding sources and populations served by the various US healthcare programs Table 1: Major US Health Insurance Programs Medicare Beneficiaries Administered by Funding source Table 2: Differentiating Medicare Parts Medicare Part A Compare and contrast the operational framework and services covered under each of the different Medicare "Parts", including anticipated costs to the patient Covered services Monthly premium? (Yes or No) Annual deductible? (Yes or No) Other costs? (Describe WHAT, not how much) Additional noteworthy aspects Deductible phase Initial coverage phase Coverage gap phase Catastrophic coverage phase Medicaid Patient pays Brand-name: Generic: Describe the overall structure of the "Medicare Part D" benefit, including copay breakdowns at the different phases Table 3: Medicare Part D Coverage Gap (Donut Hole) Part D Plan pays Medicare Part B Brand-name: Generic: Commercial / Private Insurance Pharmaceutical Manufacturer pays Brand-name: Generic: Medicare Part D "Medicare" (CMS) pays N/A N/A N/A Explain the overall structure of the Oregon Health Plan (Medicaid), including the "7-11 Carveout" Assuming a family/household of 4 in each of the following scenarios, determine the income eligibility cut-off for each of the following Medicaid populations using the Oregon Health Plan determinations: 6 month-old child: 12 year-old child: 34 year-old pregnant woman: How is the Oregon Health Plan (OHP) administered? What medications/medication classes are excluded from the Oregon Health Plan? Why are these medications excluded from the OHP? Who administers the benefits for these medications/medication classes? Categorize the various private sector insurance structures that exist in the US HMO HDHP Structure Benefits Drawbacks PPO