Question 1

Which of the following groups has undertaken innovative activities to contain the costs of health care?

Accepted Answer

All of these groups have undertaken innovative activities to contain the costs of health care. Employers can introduce wellness programs, disease management programs and negotiate deals with providers to lower costs. Labor unions have negotiated for lower drug prices, advocated for better working conditions of medical professionals to reduce medical errors, and funded health care research. Health insurers have introduced various cost containment measures such as value based insurance design, negotiating drug prices, and bundled payment models. Consumers have become informed about their health care choices, opting for more price transparency, and refuse unnecessary treatment.

Question 2

Chris Jones has an insurance policy that pays benefits in cash when he is hospitalized.What type of insurance would this be?

Accepted Answer

A hospital indemnity insurance policy is the type of insurance that pays benefits in cash when the insured person is hospitalized. This type of insurance is designed to help with expenses that are not covered by traditional health insurance. Comprehensive major medical insurance provides coverage for a wide range of medical expenses, long-term care insurance provides coverage for long-term care needs, cancer insurance provides coverage for cancer treatment, and disability income insurance provides coverage for lost wages due to disability. None of these policies pay benefits in cash specifically for hospitalization.

Question 3

Joe Johnson needs surgery for appendicitis.Which part of his basic health insurance coverage should help pay for the surgeon's fees?

Accepted Answer

The surgical expense part of basic health insurance should help pay for the surgeon's fees.

Question 4

Julie Cumbie was playing softball and got hurt sliding into second base.She gets an x-ray at her doctor's office to make sure her ankle isn't broken.Which part of her basic health insurance coverage should help pay for this x-ray?

Accepted Answer

Physician expense coverage should help pay for Julie's x-ray as it is a diagnostic test ordered by her doctor during an office visit. Hospital expense and surgical expense coverage would apply if she needed to be admitted to the hospital or undergo surgery. Major medical expense coverage generally applies to more catastrophic events and Medicare Part B is a government-funded health insurance program for individuals over 65 or with certain disabilities.

Question 5

Which of the following is an innovative way concerned groups are containing health care costs?

Accepted Answer

All of these options are innovative ways concerned groups are containing health care costs. Incentivizing preventive care can help avoid costly procedures down the line, prepaid group practices can help streamline care and reduce administrative costs, community health education programs can promote healthy behaviors and prevent chronic illnesses, and paying cash for routine medical care can be more cost-effective than going through insurance.

Question 6

Sophie Bennett has personally paid a total of $5,000 in medical costs this year,which is the out-of-pocket limit listed in her insurance plan.At this point,there is a provision in her insurance contract that requires her insurance company to pay 100% of her medical costs for the remainder of the year.What provision is this likely to be?

Accepted Answer

The stop-loss provision is a feature of an insurance policy that limits the total amount of money that a policyholder will have to pay out of their own pocket for covered medical expenses during a specified period. Once the policyholder reaches the out-of-pocket limit, the insurance company takes over the payments for the rest of the period, which is likely the case for Sophie Bennett.

Question 7

Raymond Carter has a type of all-inclusive health insurance that has a very low deductible and pays for hospital,surgical,medical,and other bills under one plan.What type of insurance does he have?

Accepted Answer

The description provided fits the characteristics of comprehensive major medical insurance, which covers a wide range of healthcare services under a single plan, including hospitalization, surgeries, and medical expenses. It typically has a low deductible and a high maximum out-of-pocket limit.

Question 8

Jamal Walker developed a serious infection and spent 6 months in his hospital's intensive care unit.What part of his health insurance policy would be the most useful for helping to pay for this?

Accepted Answer

The most useful part of Jamal's health insurance policy for helping to pay for his 6-month stay in the ICU would be the major medical expense coverage. This typically provides coverage for long-term or catastrophic illnesses, such as extensive hospital stays, and can help cover the high costs associated with these types of medical needs.

Question 9

Sophie Bennett is required to pay 20 percent of her medical costs after the deductible has been paid.What is this requirement called?

Accepted Answer

The requirement for Sophie Bennett to pay 20 percent of her medical costs after the deductible has been paid is called coinsurance.

Question 10

Harry Mayhue gets a bad case of the flu and ends up in the hospital for three days.Which part of his basic health insurance coverage should help pay for this stay?

Accepted Answer

Hospital expense coverage is designed to help cover the cost of a hospital stay, which is exactly what Harry Mayhue needed because he was hospitalized for three days due to the flu. Surgical expense coverage would only be applicable if Harry had to undergo a surgical procedure during his hospital stay. Physician expense coverage typically covers visits to a doctor's office or outpatient care, but not hospital stays. Major medical expense coverage kicks in after a certain threshold of expenses has been met, which may not have been reached in Harry's case. Medicare Part B is a separate program for individuals over the age of 65 and may not apply to Harry if he is younger than that.

Question 11

What are some possible reasons for high and rising costs of health care?

Accepted Answer

All of these factors contribute to the high and rising costs of health care. The use of expensive technologies and duplication of tests drive up costs, while the rapid earnings growth of health care professionals adds to labor costs. Additionally, the increasing number and longevity of elderly people place a greater demand on health care services, leading to higher costs overall.

Question 12

Nathanial Drummond has three different insurance policies.He has been injured in an accident and has incurred $30,000 in medical bills.There is a provision in all of his insurance contracts that ensures the total benefits he receives from all sources is limited to 100% of allowable medical expenses.What is this provision called?

Accepted Answer

This provision is called coordination of benefits, which ensures that the total benefits received from all sources do not exceed the actual medical expenses. This provision is common in situations where a person has multiple insurance policies.

Question 13

Each year,Sophie Bennett must pay $500 for doctor's visits before her insurance company will make any payments for doctor's visits.What is this requirement called?

Accepted Answer

The $500 that Sophie must pay for doctor's visits before her insurance company will make any payments is called a deductible.

Question 14

Karen Blumenthall was seriously injured in a car accident and is paralyzed from the waist down.Luckily,she has an insurance policy that will pay for someone to come in and help with her daily activities such as bathing,dressing,and household chores.What type of insurance policy is this likely to be?

Accepted Answer

Long-term care insurance policies cover the cost of personal care services, including assistance with daily activities, when the insured is unable to perform these activities themselves due to a chronic illness, disability, or cognitive impairment. This type of policy is most appropriate for Karen's situation.

Question 15

What can you do to responsibly reduce your personal health care costs?

Accepted Answer

Regular exercise and maintaining a healthy weight can reduce the risk of many chronic health conditions such as diabetes, heart disease, and high blood pressure. By preventing or managing these conditions, individuals can reduce their healthcare costs in the long run.

Answer: E
 Chronic stress and lack of relaxation have been linked to an increased risk of many health conditions, including high blood pressure and depression. By prioritizing relaxation techniques such as meditation or yoga, individuals can potentially reduce their healthcare costs by preventing or managing these conditions.

Therefore, the best choices are A and E.

Question 16

Joan Wilder receives a phone call from a salesperson who tries to sell her an insurance policy by scaring her about her high risk of death from this disease.She knows that this type of insurance policy is notoriously a poor value,so she politely declines.What type of insurance policy did this salesperson likely try to sell her?

Accepted Answer

The salesperson tried to scare Joan Wilder about her high risk of death from a disease, which suggests they were likely trying to sell her a cancer insurance policy. Cancer policies are known for being a poor value because they typically have limited coverage and high premiums.

Question 17

Most group health insurance plans in the United States are sponsored by:

Accepted Answer

Most group health insurance plans in the United States are sponsored by employers, who then offer the benefits to their employees as part of their overall compensation package. This allows for cost-sharing and risk pooling among a larger group of people, making healthcare more affordable and accessible for employees.

Question 18

Which country has the highest per capita medical expenditures of any industrialized country in the world?

Accepted Answer

According to the Organization for Economic Cooperation and Development (OECD), the United States has the highest per capita medical expenditures of any industrialized country in the world.

Question 19

Which provision in a health insurance policy states that you will pay a flat dollar amount each time you receive a covered medical service?

Accepted Answer

The provision in a health insurance policy that states that you will pay a flat dollar amount each time you receive a covered medical service is called a copayment. This is a common feature of health insurance policies and helps to ensure that policyholders have some skin in the game when it comes to their healthcare costs. Copayments can vary depending on the specific service being received and the terms of the policy, but they are usually a relatively small amount (e.g. $20-$50) that the policyholder is responsible for paying out of pocket.

Question 20

Which type of health insurance plan may not cover all of your health insurance needs and may deny benefits if you lose your job?

Accepted Answer

Group health insurance is typically provided by an employer, and if you lose your job, you may lose your coverage. It may not cover all health insurance needs as it is often limited to what the employer offers.

Quiz 11: Health, Disability, and Long-Term Care Insurance