Question 1

Medicare Part A provides:

Accepted Answer

Medicare Part A covers inpatient hospital services, skilled nursing facility care, hospice care, and home health care.

Question 2

Medicare Part B covers:

Accepted Answer

Medicare Part B covers imaging, laboratory tests, and prosthetic devices.

Question 3

People under the age of 65 are covered by the Medicare health insurance plan if:

Accepted Answer

People under the age of 65 are covered by the Medicare health insurance plan if they receive monthly Social Security disability benefits.

Question 4

The Patient Protection and Affordable Care Act (ACA) requires insurance companies to adhere to the:

Accepted Answer

The ACA requires insurance companies to adhere to the adjusted community rating approach for individuals and small businesses, which means they can only vary premiums based on age, geography, tobacco use, and individual vs. family coverage. The pure community rating approach would mean that everyone pays the same premium regardless of health status, which could lead to adverse selection and higher premiums for healthy individuals. The other options are not accurate or relevant to insurance rating standards.

Question 5

During the past few decades, the percentage of our income spent on health care:

Accepted Answer

The increase in the percentage of income spent on healthcare can be attributed mainly to an aging population. Older individuals tend to require more healthcare services, which drives up demand and costs. Additionally, advances in medical technology have contributed to increased healthcare spending, rather than decreasing it. The other options provided, such as increased regulatory measures and decreased administrative costs, are not significant enough to have a major impact on overall healthcare spending trends.

Question 6

If you are laid off, your group health insurance:

Accepted Answer

If you are laid off, you typically have the option to continue your group health insurance through COBRA (Consolidated Omnibus Budget Reconciliation Act) for up to 18 months. However, you must pay the premiums yourself, which can often be more expensive than what you were paying as an employee since your employer is no longer contributing to the cost.

Question 7

In addition to financing medical expenses, lost income, and replacement services, a good health insurance plan incorporates:

Accepted Answer

A good health insurance plan should not only cover medical expenses and lost income, but also incorporate other means of risk reduction, such as risk avoidance and risk assumption. This can include preventive care and wellness programs, as well as options for policyholders to take steps to reduce their own risk of illness or injury. Social Security benefits and life insurance are not typically included in health insurance plans, and lifetime limited dollar coverage on pre-existing conditions is no longer permitted under the Affordable Care Act. Flexibility in premium payment may be an option in some plans, but it is not a necessary feature of a good health insurance plan.

Question 8

Which of the  following statements regarding private health insurance plans is true?

Accepted Answer

Traditional indemnity plans, also known as fee-for-service plans, often offer the option of a high deductible, which can result in lower premium costs. This is because the insured assumes more of the upfront cost burden before insurance coverage begins, reducing the risk and cost for the insurer.

Question 9

The community rating approach to health insurance premium pricing:

Accepted Answer

The community rating approach prohibits insurance companies from varying rates based on health status or claim history, instead setting premiums based on the overall risk of the entire community. This helps to ensure that individuals with pre-existing conditions or past health issues are not charged higher premiums than others, making health insurance more accessible and affordable for all.

Question 10

When offering a flexible-benefit plan, most employers will set up a salary reduction agreement with an employee if the employee:

Accepted Answer

A salary reduction agreement is used to allow employees to contribute pre-tax dollars to their flexible-benefit plan. This option is usually offered to employees who want additional insurance benefits beyond what the employer is offering.

Question 11

Ben (age 40) pays a low ($15) co-payment each time he visits a doctor or hospital. Other than the low per-service deductible, there is very little cost sharing. However, Ben has a relatively low deductible, has no exclusions, and does not have to file insurance claims. Which of the following most likely provides Ben's health coverage?

Accepted Answer

The characteristics described, such as a low co-payment for services, little cost sharing beyond the deductible, no exclusions, and not having to file insurance claims, are typical of a Health Maintenance Organization (HMO). HMOs often provide comprehensive health services to their members for a fixed, prepaid fee, emphasizing preventive care and requiring members to use a specific network of doctors and hospitals.

Question 12

One of the key goals of the Patient Protection and Affordable Care Act (ACA) is:

Accepted Answer

The key goal of the ACA is to reduce the number of uninsured citizens in the country by providing access to affordable health care coverage. This is achieved through various measures such as expanding Medicaid, establishing health insurance exchanges, and offering subsidies to low-income individuals and families to help them purchase insurance. The ACA does not aim to increase Social Security taxes, provide coverage exclusively to small employers, underwrite employee health care coverage, or penalize employers for job-related illnesses or injuries.

Question 13

Which of the following is a public assistance program that provides health insurance benefits only to those who are unable to pay for health care?

Accepted Answer

Medicaid is a public assistance program that provides health insurance benefits only to those who are unable to pay for health care. Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Blue Cross/Blue Shield plans and Point-of-service (POS) plans are private insurance options. Workers' compensation insurance is a type of insurance that provides benefits to workers who are injured on the job.

Question 14

An exclusive provider organization (EPO) is a:

Accepted Answer

An exclusive provider organization (EPO) is a managed care plan that only covers services if the member receives care from providers who are affiliated with the plan. Unlike a preferred provider organization (PPO), EPO members cannot go outside of the network for care, except in emergencies.

Question 15

Funds for Medicare benefits come from:

Accepted Answer

Medicare is funded through Social Security taxes paid by covered workers and their employers.

Question 16

A _____ is a hybrid form of health maintenance organization (HMO) that allows members to go outside of the HMO network for care.

Accepted Answer

A point-of-service (POS) plan is the hybrid form of HMO that allows members to go outside the HMO network for care. It provides more flexibility to the members but often, comes with higher out-of-pocket costs.

Question 17

_____ is a health care plan in which subscribers / users contract with the provider organization, which uses a designated group of providers meeting specific selection standards to furnish health care services for a monthly fee.

Accepted Answer

The description matches that of a managed care plan, where subscribers contract with a provider organization for a set fee in exchange for a designated group of providers meeting specific standards. Indemnity plans and fee-for-service plans typically allow for more flexibility in choosing providers, while a supplementary medical insurance plan is an add-on to traditional Medicare. Medicare itself is a government-run health insurance program for those over 65 or with certain disabilities.

Question 18

Medicare's supplementary medical insurance (SMI) provides health care protection beyond the basic hospital coverage for:

Accepted Answer

Medicare's supplementary medical insurance (SMI), also known as Part B, is available to anyone age 65 or over who pays premiums on a voluntary basis.

Question 19

Which of the following statements regarding workers' compensation insurance is true?

Accepted Answer

Workers' compensation insurance compensates workers who are injured on the job or become ill through work-related causes. The federal government provides guidelines and oversight for workers' compensation programs, but each state sets its own laws and regulations. The cost of workers' compensation insurance is typically covered entirely by the employer, and premiums are based on the industry classification and the employer's claims history, not the number of claims filed.

Question 20

With a traditional indemnity (fee-for-service) plan, the:

Accepted Answer

A traditional indemnity (fee-for-service) plan allows the insured to choose any healthcare provider they want. The health care provider and the insurer are separate entities and the insured pays for services rendered and then submits a claim to the insurer for reimbursement.

Quiz 9: Insuring Your Health