Exam 2

Question 1

Premium

Answer 1

Dues or monthly payment you make for health insurance

Question 2

Health Savings Account

Answer 2

accounts for people with high deductible health plans to save for the health care expenses.

Question 3

HMO: Health Maintenance Organizations;

Answer 3

health networks that are driving by referrals with in a provider network.

Question 4

Healthcare Freedom Act

Answer 4

This was repeal and replace attempt, which got rid of the mandates. It kept all of the ACA except the individual mandate and the partial employer mandate. This was known as the “skinny repeal”

Question 5

Medicaid

Answer 5

Government sponsored health insurance for low income people.

Question 6

Co-insurance

Answer 6

the percentage of costs of a covered health care service that you pay after you have paid the deductible.

Question 7

Affordable Care Act

Answer 7

passed in 2010, and worked on increasing access to quality health insurance while making it more affordable. The ACA was really about access and cost. There were 4 key changes put upon by the ACA. They included;
o The establishment of 10 essential benefits all plans had to carry.
o No retribution on preexisting conditions
o No annual or lifetime limits
o Parents insurance until 26.

Question 8

Medicare Part C

Answer 8

Provides for Medicare Advantage plans, where someone in Medicare can enroll in a private health plan, but you can only use the providers in the plan

Question 9

Insurance Exchange

Answer 9

were markets that were setup to help people shop plans on the individual market so they can compare coverage and plans.

Question 10

Individual Mandate

Answer 10

Requires all people to have insurance and levy’s a a tax penalty on people who are not insured.

Question 11

American Health Care Act

Answer 11

This was the first Repeal and replace attempt; this proposal got rid of Medicaid Expansion, but would have allowed people to stay in their parent’s insurance until they were 26, required coverage for preexisting conditions, kept the lifetime limits ban and the tax subsidies but they would have been leaner based on age not income.

Question 12

Preexisting Condition

Answer 12

when someone is born with an illness, which could have precluded them from having health insurance prior to the ACA.

Question 13

Annual/Lifetime Limit

Answer 13

This change set forward that health plans cannot set limits on medical coverage.

Question 14

Medicare

Answer 14

was a plan that the government developed in the 1960s, and is for people who are 65 or older, or those who are disabled and cannot work.

Question 15

High-Risk Pool

Answer 15

insurance pool that is set up for the sickest people.

Question 16

Out of Pocket Maximum

Answer 16

the maximum amount that you will pay on your own for health care.

Question 17

10 essential benefits

Answer 17

ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health services, prescription services, rehab, and habilitative services, lab services, preventive and wellness services, pediatric services.

Question 18

Acturarial value

Answer 18

The average cost that your insurance company is going to pay.

Question 19

Employer Mandate

Answer 19

requires that employers with more than 50 employees provide health insurance.

Question 20

PPO Insurance Plan

Answer 20

Health insurance plans that do not require a referral or have a closed referral network. any provider in or outside of network without referral. They are most costly than another plan, and out-of-network care will also way be more costly than out-of-network care.

Question 21

Experience Rating

Answer 21

Look at risks within groups, and you pay based on the level of risk, sicker people are going to pay more, younger more invincible people will like these plans.

Question 22

Medicare Part B

Answer 22

provides for supplemental physician coverage

Question 23

Universal Healthcare

Answer 23

all people would have access to health services when they needed them with out any financial hardship (health care at no cost to the consumer).

Question 24

Community Rating

Answer 24

Is used in response to physician driven unpredictable costs. In a community rating system everyone pays the same rate, but there is more risk within and across groups.
In a community rating you all pay the same, and its for high risk jobs that are accident- generally these work under the idea that if you pay more now, someone is going to help pay for you later.

Question 25

Deductible

Answer 25

What you owe before the cost sharing starts

Question 26

Underinsurnace

Answer 26

people who cannot afford their own health insurance but that make too much money to qualify for Medicaid.

Question 27

Medicare Part D

Answer 27

provides for prescription drug coverage, this is a voluntary benefit.

Question 28

Explain why the U.S Health system is called a patchwork ?

Answer 28

The united states have what is called a “patchwork system” because the health care system keeps changing incrementally, with no single-payer.

Question 29

What were some of the changes that were proposed to the ACA

Answer 29

American Health Care Act (AHCA):

Better Care Reconciliation Act (BCRA):

Obamacare Repeal Reconciliation Act of 2017:

Healthcare Freedom Act of 2017:

Graham-Cassidy-Heller-Johnson Amendment:

Question 30

American Health Care Act

Answer 30

Was the first proposed replacement for the ACA;
In 2017 the AHCA would have gotten rid of Medicaid Expansion but would have allowed people to stay in their parent’s insurance until they were 26, required coverage for preexisting conditions, kept the lifetime limits ban and the tax subsidies but they would have been leaner based on age not income.

Question 31

Better Care Reconciliation Act

Answer 31

Better Care Reconciliation Act (BCRA):
This proposal had many of the similar proposals from AHCA and also included a partial employer mandate, it also got rid of the 10 essential benefits in insurance plans. and it failed in the Senate, 43 to 5

Question 32

Obamacare Repeal Reconciliation Act fo 2017

Answer 32

Kept all of the ACA but it ended expanded Medicaid, ended the individual mandate, and got rid of the partial employer mandate. This bill also created insurance exchanges.

Question 33

Healthcare Freedom Act of 2017

Answer 33

This one would be known as the “Skinny repeal and replace” bill, it kept all of the ACA except the individual mandate, and the partial employer mandate.

Question 34

Graham- Cassidy-Heller- Johnson

Answer 34

Got rid of the 10 essential benefits, ended expanded Medicaid, and the mandates (individual and employer)

Question 35

Medicaid Per Capita Cap

Answer 35

this made some changes to the way Medicaid is financed. This proposal established caps on how much the federal government pays by enrollee. This proposal would help to balance the federal budget and reduce the deficit, keeps federal Medicaid spending constrained. However, this proposal does not allow changes in treatment costs, and it is difficult to determine correct per capita amount

Question 36

High risk pool

Answer 36

*These are insurance pools for individuals with pre-existing conditions; these plans allowed people to purchase more expensive plans, with lower premiums for non-preexisting conditions. However, these plans are not sustainable to only heave sickest people. Does not address high premium affordability.

Question 37

Market Placed Healthcare Grant Program

Answer 37

These are state block grant programs for state’s to fund health programs, specifically high risk pools and subsidized premiums in the private market.

Question 38

Current policies impact teh ACA

Answer 38

The tax cut and the jobs act both repealed the penalty for the individual mandate and CMS recently made a policy announcement that allows states for apply waivers for Medicaid Eligibility.