Module 1 Flashcards

1
Q

Spreading Risk over a large Homogeneous Group

A

Pooling

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2
Q

An unforeseen, unexpected, non-speculative event

A

Random Loss

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3
Q

The purchase of insurance when one anticipates having claims.

A

Adverse Selection

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4
Q

Unneeded health services may be used when the consumer isn’t paying the full cost for them.

A

Moral Hazard

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5
Q

Requires insureds to pay a certain percentage of eligible medical expenses and the insurance company covers the rest i.e., 20%/80%

A

Coinsurance

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6
Q

The amount that individuals must pay before their insurance plan starts to pay

A

Deductible

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7
Q

A cost share expressed as a dollar amount, such as $25 for an office visit.

A

Copayment

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8
Q

Provides hospital and some skilled nursing facility coverage.

A

Medicare Part A

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9
Q

Covers physician and similar services

A

Medicare Part B

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10
Q

Also known as Medicare Advantage Plans

A

Medicare Part C

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11
Q

Pharmacy

A

Medicare Part D

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12
Q

A public insurance program that provides health coverage to low-income families and individuals.

A

Medicaid

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13
Q

A private insurer or a public program, which pays for all or part of a patient’s healthcare services.

A

Third-party payers

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14
Q

Provide network and non-network choices without need for a PCP (gatekeeper)

A

Preferred provider organizations (PPO)

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15
Q

Theoretically, they give consumers “skin in the game”.

A

High-Deductible Health Plans (HDHP)

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16
Q

Federal/state level rules that required people to purchase health insurance or face a penalty

A

Individual Mandate

17
Q

Favorably impacts wellness and prevention aspects of health care design and delivery.

A

The ACA

18
Q

The provision of care is based on value, not volume.

A

Value-Based Care