block 1, 2 and 5 old quiz

Question 1

what are the primary players in health care marketplace

Answer 1

patients
providers
payers

Question 2

which are following examples of cost sharing

Answer 2

deductibles
co pay
co-insurance

Question 3

what is an example of gov as a payer

Answer 3

medicare
medicaid
tricare

Question 4

which of the following may be sources of payment to providers in exchange for good/service

Answer 4

cost sharing
payment by insurer
goverment payment

Question 5

What is most likely to happen if the following conditions apply?

No Guaranteed Issue
No Individual or employer mandate
Community Rating

Answer 5

individual with pre-exisiting conditions will be more likely to be denied coverage

Question 6

Which of the following is most financially risky for insurance companies?

Answer 6

large and sick pool

Question 7

The goal of underwriting is to:

Answer 7

minimize risk for the insurer

Question 8

Which of the following is MOST likely to occur in a state with a single health insurance company offering policies?

Answer 8

higher premiums

Question 9

Which of the following is a cultural belief that has contributed to challenges with reforming the US Healthcare system?

Answer 9

distrust in large gov

Question 10

Which of the following was common insurance company practice prior to the ACA?

Answer 10

selling policies with annual benefit caps

Question 11

States in which region of the United States are most likely to have the highest rates of pre-existing conditions?

Answer 11

southeast

Question 12

During which era were physicians essentially the only provider of healthcare?

Answer 12

pre-industrial

Question 13

When a patient visits her physical therapist, she is required to pay a percentage of the bill out of pocket. She is MOST LIKELY to have:

Answer 13

PPO

Question 14

A patient’s employer ultimately pays the cost of any healthcare claims. She is MOST LIKELY to have:

Answer 14

ERISA plan

Question 15

Which of the following is NOT TRUE about Consumer Directed Health Plans, or High Deductible Plans with a Health Savings Account (abbreviated HSA’s)?

Answer 15

HSA tend to cost more in premiums than PPOs

Question 16

Which of the following is TRUE regarding HMO’s compared to PPO’s?

Answer 16

HMO a patient almost always must obtain a PCP referral to see a specialis, but not in a PPO

Question 17

Which of the following are true about Health Maintenance Organizations (HMO’s)? Typically:

Answer 17

lower out of pocket costs at time of service than a PPO

Question 18

A beneficiary’s insurance policy is 80/20 with out of pocket cost based on provider charges. His plan is structured to pay:

Answer 18

fee for service

Question 19

If a patient’s insurance plan is an HMO, are they MORE LIKELY to pay a co-payment or co-insurance?

Answer 19

co-payment

Question 20

Every time a patient is seen in a physical therapy clinic, the clinic receives a flat contracted amount. This is called:

Answer 20

payment per diem

Question 21

A hospital negotiates with an insurer based on a reduced fee schedule to provide all services for an individual after an ACL reconstruction, including surgery, hospitalization and post-operative care. This is called:

Answer 21

payment per episode

Question 22

Jason works for a small employer (25 employees), and purchased a family health insurance policy through the company. He chose a plan with a $100,000 per person Annual Maximum Benefit. The plan had no yearly out of pocket maximum. Jason was cleaning his gutters and fell off the ladder at home, sustaining a severe traumatic brain injury. The total bills in the first 2 months were $150,000. Who will be responsible for paying the bills over $100,000? CONSIDER THE CONCEPT OF THE ANNUAL MAXIMUM BENEFIT ONLY. DO NOT CONSIDER ANY CHANGES THAT HAVE OCCURRED AS A RESULT OF HEALTHCARE REFORM

Answer 22

jason and his family

Question 23

A public health insurance program that provides both hospital insurance and supplemental medical insurance

Answer 23

medicare

Question 24

Providers that submit claims for Medicare Part A services include:

Answer 24

hospital

Question 25

Medicare is a Federal health insurance program following qualify:

Answer 25

age 65 and older
under 65 but considered disabled by cms
end stage kidney disease

Question 26

In order to enroll in Medicare Part C, individuals must be eligible for Medicare, but they do not receive their Medicare through Original Medicare.

Answer 26

true

Question 27

Original, also called Traditional Medicare, includes which of the following Parts

Answer 27

part a and b

Question 28

Medigap helps pay some (or sometimes all) of the cost-sharing that Part A and Part B doesn’t cover

Answer 28

true

Question 29

Medicare beneficiaries may choose to have their Hospital and Medical benefits administered through a private company if they enroll in:

Answer 29

part c

Question 30

Choose the type of care that is NOT covered by Medicare Part B:

Answer 30

inpatient hospital facility services

Question 31

medicare open enrollment is a time period when individuals ca

Answer 31

enroll in orginal medicare and choose to enroll in medicare advantage

Question 32

which may include vision and perscription drugs

Answer 32

part c

Question 33

An individual who enrolls in Medicare Advantage must also enroll in a Medigap plan.

Answer 33

false

Question 34

why was the 75% rule developed

Answer 34

overutilization of inpatient rehav services over lowering cost settings

Question 35

did the 75% rule become implimented

Answer 35

no stoped at 60%

Question 36

which of the following applies to financing of medicare part b

Answer 36

premiums are collected from beneficiaries and cover 25% of the plan remainder comes from general tax revenue

Question 37

Which of the following is TRUE for a Medicare beneficiary who signs up for a Part C plan?

Answer 37

Part C insurers often provide additional covered bundled benefits like Dental and Vision.

Question 38

is custodial care covered by medicare

Answer 38

no

Question 39

Which of the following is true about the Colorado Medicaid waiver for children example discussed in class/module?

Answer 39

The Medicaid waiver “waive” a family’s income, and use the child’s income as a determinant of eligibility criteria