Final Exam! Flashcards
What is a Consumer Directed Health Plan (CDHP)?
It is a high deductible heath plan with a health savings account
True/False: The rational behind CDHP is that consumers will have enough money saved up so that they won’t have to worry about how much they spend on healthcare.
False! The goals of HDHP/CDHP is to make people more cost conscious.
HSAs and FSA are similar in that they are both “use it or lose it” accounts.
False! Those funds roll over. Flexible spending accounts are a “use it or lose it” account
The small group market is typically defined as firms with how many employees?
Less than 50 employees
Ture/False: Employers with 50 or fewer full-time employees are not subject to the “pay or play” mandate in the ACA; they are not required to offer insurance coverage to their workers or face penalty of $2000 per worker.
True.
HSA: main characteristics, how do they work, what are they typically combined with, who they’re good for, what are the tax benefits
It is a tax-sheltered financial account into which individuals or their employers may contribute funds and from which individuals may withdraw money to pay for qualified health services. Typically combined with a HDHP.
CDHPs: rationale behind them (moral hazard, RAND, etc)
HSA with a HDHP. The more people have to pay our of pocket the less they will use the services in general. High deductible encourages low spending.
Talk about the growth of CDHPs
Ok!
Medicaid, main characteristics, who funds it, who decides what they’re gonna cover and eligibility requirements, talk about CHIP who funds it, how you qualify, how the
qualification for CHIP differ from the qualifications for Medicaid
Medicaid is primarily for pregnant women, children, the elderly and the disabled. Funded both by federal and state government with some benefits required to be covered and others that are state specific. 138% of FPL for Medicaid with PPACA expansion.
Federal and state still cover CHIP, though the fed provides a 15% higher matching rate than Medicaid (65-83% of total costs). Qualify by being up to 350% of FPL at state’s discretion.
What is crowd-out?
Crowd-out is when a public program, like Medicaid, causes people to drop private coverage and shift to a free/lower-costing public program.
People leaving private insurance for Medicaid, for example.
Long-term care insurance, what it is, why people should have it, and why they don’t
It’s insurance for LTC (like nursing homes, home health, SNF, etc.) People should have it as must of 65 or older use LTC. Costs are high and most just spend all they have till they qualify for Medicaid.
Medicare: know the 4 parts, what each part covers, how each is funded, the characteristic that sets that part apart and trends for the future.
Medicare is a federal program for those individuals who are 65 years of age, disabled and/or have need of end-stage renal dialysis
Medicare Part A is funded by HI trust fund
Medicare Parts B and D are funded by the SMI trust fund and income tax
The future of Medicare is currently unsustainable. The HI trust fund will be exhausted by 2030.
Describe the original Hospital Service Plans
Baylor plan was a hospital plan for 1 hospital, it later evolved into blue cross and was the primary guide for Medicare part A
Describe the original “Prepaid Group Practice”
Started in LA, doctors were kicked out of the community, evolved into blue shield and guide to medicare part B
Private Health insurance grew rapidly during the 1940s and 1950s. Explain at least 2 reasons why.
Wage and price controls
Organized Labor
Federal Tax Codes
Full names and characteristics of HMO PPO and POS
Point Of Service: most expensive (preventative care and takes on the cost of the patient), very limited network
What does “Self-Insure” mean?
Self insuring is when you make conscious decision to bear the underwriting risk and to to not have a typical insurance plan. Rather, you set money aside to pay for your health care needs.
What is “risk premium”?
The most amount of money we are willing to pay to avoid the consequence of loss
What is “risk aversion”? How does a person’s degree of risk aversion affect his/her level of insurance
As they are more risk averse, they are willing to get “better” insurance
Explain 2 advantages of purchasing health insurance through an employer
Employers offer more options
Tax benefits
What is “Adverse Selection”?
Consumers buy insurance based on which services they know they will use, thus they select the best plan for their needs
What is the “HMO effect”?, Explain at least 2 examples
HMO effect uses PCPs to keep people out of hospitals
Use ASCs over hospitals
Gatekeeper PCP
What is “Favorable Selection”?, Explain at least 2 examples
Favorable selection attracts low utilizers
Marketing to areas of low utilizers
Targeting younger generation
