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Question 1

what factors should consider when deciding what health insurance plan to buy?

Answer 1

1. cost of the monthly premium
2. how much coverage you will get -medical ailments
   3.deductible
3. co pay
4. can i get the doctor i want

Question 2

how can u purchase health insurance

Answer 2

1. employer plans
2. group plans
   3.cobra plans

Question 3

what is the cost of insurance fraud to the consumer

Answer 3

your premiums go up

Question 4

name a well known health care program for low income individuals

Answer 4

medicaid

Question 5

how can you personally reduce the need to use your health care plan

Answer 5

eat healthy, don’t rush right away, exercise, sleep, avoid risk, hygiene

Question 6

why do people buy/have health insurance

Answer 6

fear of debt and emergencies like surgery so you dont have to pay out of pocket

Question 7

why is medicare in trouble

Answer 7

have to be elderly or disabled to receive the benefits. baby boomers are going into retirement and life span getting longer so more people are taking money out of the pot which has caused less money to be able to give out.

Question 8

what are 3 ways to coverage disability

Answer 8

workers compensation, social security, private income insurance program

Question 9

why is healthcare so expensive

Answer 9

technology, equipment, increasing number of crime rates, increasing number if elderly

Question 10

HMO definition

Answer 10

A health insurance plan that directly employs or contracts with selected physicians and other medical professionals to provide healthcare services for a fixed prepaid monthly income. 

Question 11

Blue cross

Answer 11

A state wide organization, similar to private health insurance that provides health insurance and hospital care benefits 

Question 12

point of service plan

Answer 12

combines features of both HMO and PPO. You are allowed to seek care from physicians outside of the networks, but at a higher charge. 

Question 13

copayment

Answer 13

A flat fee that you pay every time you visit a doctors office and you receive a covered service 

Question 14

managed care

Answer 14

prepaid health plans that provide comprehensive health care to their members 

Question 15

blue shield

Answer 15

A state wide organization that provides health insurance and benefits for surgical and medical services performed by physicians 

Question 16

medigap insurance

Answer 16

supplements Medicare, by filling in the gaps between Medicare payments and medical cost not covered my medicine

Question 17

coinsurance

Answer 17

The percentage of the medical expenses, the policyholder must pay in addition to the deductible amount 

Question 18

deductible

Answer 18

A set amount that the policyholder must pay toward medical expenses before the insurance company pays benefits 

Question 19

stop loss

Answer 19

A provision that requires the policyholder to pay all costs up to a certain amount after which the insurance company pays 100% of the remaining expenses as long as they are covered in the policy 

Question 20

The smith family has insurance for all of its family members. Mr. Smith has health insurance that covers 70% of out of hospital expenses including prescriptions after a $500 deductible per person. It’s the beginning of the year and Mr. Smith’s first doctor/prescription expenses total is $2000. What amount will insurance pay?

Answer 20

step one: 2000-500=1500
step two: 1500x.70=1,050(ins. pays)
step three: 2000-1050=950(mr. S pays)

Question 21

Betty has taken home $1500 a week. Unfortunately she is unable to work and must stay out of work for 20 weeks. What is the total amount Betty will receive for her entire time on disability? How much will Betty be short each week from her normal take home pay?

Answer 21

step one: 1500x.65=975
step two: 975x20=19,500(ins. pays)
step three: 1500x20=30,000(if not injured)
step four: 30,000-18500=10500(losing)

Question 22

Gus has a health insurance policy that pays 75% of physical therapy costs after a $200 deductible. In contrast, Jim has HMO insurance that charges a flat fee of $25 per visit for each physical therapy session. If they each need 10 physical therapy sessions that cost $60 for each session who is paying the lesser total amount for physical therapy, Gus or Jim? How much less is Gus or Jim paying? 

Answer 22

step one: 60x10=600-200=400
step two: 400x.75=300(ins. pays)
step three 600-300(gus pays)
step four: 25x10=250(jim pays)
step five: 60-25=35
step six:35x10=350(ins. pays)
jim pays $100 less!!!