Health Insurance Intro

Question 1

A ______ is the entrance fee to have health insurance. It is a pre-payment. The insurer negotiates prices and pays for some share of services on your behalf

Answer 1

Premium

Question 2

Nearly all insurance plans involve some degree of cost sharing. _____ are what you pay out of pocket. There are two forms of cost sharing: _______ is you pay a set percent of the price of a given service. ______ is you pay a set amount for the price of a given service.

Answer 2

Deductibles
Co-insurance
Co-payment

Question 3

Cost sharing implications are highly studied. Three key points: people do respond to ____ in healthcare (people use more services if they are cheaper). Even small amounts of cost sharing can ____ service use. Individuals cut back on the more and less clinically important services in response to _____ cost sharing

Answer 3

Prices
Deter
Higher

Question 4

Health insurance plans define the ____ of providers that the insurer will pay.

Answer 4

Network

Question 5

Insurance arrangements may involve ______ _____ (ex: prior authorization) these are things that the insurer does to exert some control over the services being used

Answer 5

Utilization management

Question 6

Insurers negotiate _____ with providers

Answer 6

Fees

Question 7

The fundamental tension of health insurance: we want some cost to prevent people from ______ healthcare BUT increasing cost sharing will increase ______ costs for those who needs care and prevent people from using clinically important services

Answer 7

Overusing
Out of pocket

Question 8

Types of insurance in the US

Answer 8

Question 9

_____ million of Americans were uninsured in 2019. ______% of the non elderly were uninsured

Answer 9

29.2
10.8

Question 10

The main reason why people are uninsured is because ____ is too high

Answer 10

Cost

Question 11

Almost ____% of uninsured people live above the poverty line but below what is would take for insurance to be considers affordable on the open market

Answer 11

80

Question 12

_____ doesn’t cover everyone over 65- you must have paid in and be a permanent resident or citizen and lived in the US for the past 5 years

Answer 12

Medicare

Question 13

_____ varies by state and covers only the lowest income residents and a subset with documented disabilities who qualify and renew their paperwork

Answer 13

Medicaid

Question 14

Only ___% of uninsured people live in a household with no employment

Answer 14

15

Question 15

Medicare part __ is automatic, anyone who is a citizen and has worked and paid taxes qualifies

Medicare part __ is voluntary, enroll and pay a premium

Answer 15

A
B

Question 16

CMS stands for Center of Medicare and Medicaid services

Answer 16

Review

Question 17

Part A covers hospital and post hospital _____ care

Part B covers ____ care

Answer 17

Inpatient
Outpatient

Question 18

Traditional Fee for service Medicare does not cover ____ or ____. It does not cover ____ care. It does cover outpatient _____ and ____ physicals

Answer 18

Heading aids
Glasses
Long-term
Medications
Preventative

Question 19

There are still out of pocket costs for Medicare including _____, _____, and ____

Answer 19

Premium, coinsurance, deductible, copayment

Question 20

The part A detectable in 2021 is _____. You are responsible for paying this amount if you’re hospitalized. Then insurance kicks in. The part B deductible is ____ per year

Answer 20

$1484
$203

Question 21

_____ insurance is a payment to CMS to pay for some of the costs that are not covered by traditional Medicare. Cost $70 to $750 per month

Answer 21

Supplemental

Question 22

The payment follows the service. Fee for service Medicare money goes to _____ and _____

Answer 22

Hospitals
Physicians

Question 23

Medicare advantage is part ___. People enroll in a Medicare advantage health plan, CMS provides an amount of money to that MA health plan. Then patients engage the healthcare system, that MA plan reimburses the hospital and patients for the services provided. The more people that join the plan, the more money the MA health plan receives from CMS

Answer 23

C

Question 24

The MA plan has ____ over the last few years. Why? CMS created this MA plan so they are saving money through transferring the risk onto MA instead of them. If MA is more efficient than CMS, they make money as well

Answer 24

Grown

Question 25

Medicare part ___ is prescription drug coverage

Answer 25

D

Question 26

Diagram:

Answer 26

Question 27

Part D plans have premiums, copays, etc. they also have _____ that vary in price. The ____ ____ (donut hole) refers to when people spend a lot of money of prescription medications there is a level where coverage stops

Answer 27

Tiers
Coverage gap

Question 28

_____ covers disabled people and people who are economically disadvantaged

Answer 28

Medicaid

Question 29

Medicare is a ____ program, Medicaid is both a ____ and ___ program

Answer 29

Federal
Federal and state

Question 30

____ million people enrolled in Medicaid in 2021. $600 billion was spent on Medicaid and $800 billion was spent on Medicare in 2019

Answer 30

75

Question 31

____ set its own criteria for Medicaid coverage

Answer 31

States

Question 32

Diagram

Answer 32

Question 33

Diagram

Answer 33

Question 34

For a family of 4 with kids, Minnesota gives about _____ per year

Answer 34

$75,000

Question 35

_____% of MN population is covered by Medicaid

Answer 35

17

Question 36

A lot of what Medicaid is used for is ____ care

Answer 36

Long term