Deck 18: Private and Government Healthcare Systems

Question 1

Medicaid is the largest source of funding for medical and health-related services for poor people. Within broad national guidelines established by federal statutes, regulations, and policies, each state must:

A) establish its own eligibility standards.
B) determine the type, amount, duration, and scope of services.
C) set the rate of payment for services.
D) administer its own program.
E) All of these are correct.

Answer 1

E

Question 2

A client opting to enroll in a point-of-service plan would expect which of the following?

A) The primary care physicians usually make referrals to other providers in the plan.
B) If the physician makes a referral out of the network, the plan pays all or most of the bill.
C) If the client refers him/herself to a provider outside the plan and service is covered by the plan, copayment and deductibles would increase significantly.
D) All of these are correct.

Answer 2

D

Question 3

In 2002, Medicare started to pay qualified _________________ who enrolled in the Medicare program as providers.

A) physicians
B) nurses
C) dietitians
D) food service managers

Answer 3

C

Question 4

Programs of All-Inclusive Care for the Elderly (PACE) provides an alternative to institutional care for persons ______ and older.

A) 45
B) 50
C) 55
D) 60

Question 5

Mike is receiving services from a state Medicaid program. He will receive all of the following except:

A) physician services.
B) housecleaning services.
C) vaccines for children.
D) nurse/midwife services.

Question 6

Which program provides services to people who are 65 years old, are disabled, or have permanent kidney failure?

A) Medicare
B) State Children's Health Insurance Program
C) Medicaid
D) Temporary Assistance for Needy Families

Question 7

The gaps in Medicare coverage include which of the following?

A) Copayments
B) Cocharges
C) Prepayments
D) Precharges

Question 8

Which of the following is the main concern regarding the fee-for-service plan?

A) It discourages vital care.
B) It eliminates prevailing fees.
C) It discourages managed care.
D) It encourages unnecessary care.

Question 9

Which type of fee-for-service plan covers some hospital services and supplies, x-rays, and prescribed medicine?

A) Major medical
B) Basic
C) Health maintenance
D) Managed

Question 10

Which of the following describes independent groups of physicians that contract with HMOs to provide services to enrollees?

A) The group model
B) The staff model
C) The group committee
D) The staff committee

Question 11

Jim has an income that is too high to qualify for state medical assistance and cannot obtain private insurance. He wants his children covered for insurance and doesn't know what to do. Which federal government program was created to help people like Jim?

A) Program of All-Inclusive Care for the Elderly
B) State Children's Health Insurance Program
C) The Personal Responsibility and Work Opportunity Reconciliation Act
D) Medigap

Question 12

Which act is known as the Welfare Reform Act?

A) Balanced Budget Act
B) U.S. Healthcare Reform Act
C) The Personal Responsibility and Work Opportunity Reconciliation Act
D) Social Security Act

Question 13

Which of the following describes a payment method in which each provider, such as an HMO, receives a flat annual fee for each individual, regardless of how often services are used?

A) Premium
B) Health insurance
C) Copayment
D) Capitation

Question 14

Stacy needs to apply for Medicare to pay for some of her medical expenses. She needs to go to the ____________ to obtain more information and to apply.

A) Department of Public Health
B) U.S. Department of Health and Human Services
C) Local Social Security Administration office
D) Community health center

Question 15

John recently found out that there are significant gaps in his Medicare coverage. This means that some of his medical services will not be covered, including:

A) excess charges by doctors who do not accept Medicare assignments.
B) supplies that Medicare does not cover.
C) long-term nursing care.
D) custodial care, dentures, dental care, eyeglasses, and hearing aids.
E) All of these are correct.

Question 16

People in the highest income households are more likely than those in lower income households to report their health status as good.

Question 17

Medicare is the designated health insurance for pregnant and lactating women.

Question 18

The National Center for Health Statistics defines health insurance as a broad term that includes private and public payers who cover medical expenditures incurred by a defined population in a variety of settings.

Question 19

Medicare Supplemental Insurance, also known as Medigap, was developed to provide medical coverage to pregnant women.

Question 20

Medicaid provides health care services to low-income persons with family incomes below 133 percent of poverty level, 65 years and older, disabled individuals, infants and pregnant women, and the blind.

Question 21

Medicare is the designated health insurance for the aged and disabled.

Question 22

In the United States, the risk of becoming uninsured increases significantly for the working poor.

Question 23

The main function of the Affordable Care Act (ACA) is to produce private health insurance exchanges in every state.

Question 24

Capitation is a payment method in which each provider, such as an HMO, receives a flat annual fee for each individual regardless of how often services are used.

Question 25

Copayment is a specified amount that health insurance organization must pay for a specified service or procedure (e.g., $20 for an office visit).

Question 26

A premium is a periodic payment required to keep an insurance policy requirement.

Question 27

List five services that the state Medicaid programs can provide.

Question 28

What is the difference between private and government health insurance?

Question 29

Which agency administers Medicare and Medicaid?

Question 30

What is the term of the following definitions:
-Combination of traditional fee for service and HMO.

Question 31

What is the term of the following definitions:
-Plan where the physician sets a price for each type of service delivered, and the client or insurance companies pay the fee.

Question 32

What is the term of the following definitions:
-System that handles the cost and delivery of health care services, the quality of that health care, and access to care.

Question 33

What is the term of the following definitions:
-Coverage offered through one's own employment or a relative's employment.

Question 34

What is the term of the following definitions:
-Made up of private physicians in private offices to provide services to HMO members and clients with other forms of insurance.

Question 35

What is the term of the following definitions:
-Prepaid group practice plan that offers health care services through group of medical practitioners.

Question 36

Which of the following is coverage offered through one's own employment or a relative's employment? It may be offered by an employer or by a union.

A) Employment-based health insurance
B) Fee-for-service plans
C) Medicare
D) Preferred provider organization

Question 37

Which of the following is made up of private physicians in private offices who provide services to HMO members as well as clients with other forms of insurance?

A) Preferred provider organization
B) Individual practice associations
C) Medicare
D) Fee-for-service plans

Question 38

Medicare legislation provides hospital and medical insurance to which of the following demographics?

A) Elderly persons
B) Permanently and totally disabled persons
C) People with end-stage renal disease (ESRD)
D) All of these are correct.

Question 39

Which of the following is a type of private insurance coverage that may be purchased by an individual enrolled in Medicare to cover some needed services that are not covered by Medicare?

A) The Balanced Budget Act
B) Programs of All-Inclusive Care for the Elderly
C) The Affordable Care Act
D) Medigap

Question 40

Which of the following provides an alternative to institutional care for individuals age 55 or older who require a nursing facility level of care?

A) The Balanced Budget Act
B) Programs of All-Inclusive Care for the Elderly
C) The Affordable Care Act
D) Medigap

Question 41

All of the following are aims of the Affordable Care Act except:

A) expanding health insurance coverage to include uninsured Americans.
B) improving the quality of coverage and health care.
C) serving as a cost-saving mechanism.
D) permitting insurance fraud.

Question 42

The Affordable Care Act states that health plans must offer a minimum level of benefits to qualify for inclusion in state exchanges, including all except which of the following?

A) Inpatient
B) Outpatient
C) Cosmetic
D) Emergency

Question 43

The Affordable Care Act emphasizes coverage for preventive services and a reformed delivery system that includes which of the following?

A) Primary care providers
B) Medical homes
C) Community-based health centers
D) All of these are correct.

Question 44

The new structure of the Affordable Care Act focuses on preventive care and wellness, and a client-centered approach to treating and managing various:

A) insurance policies.
B) income brackets.
C) geological locations.
D) chronic diseases.

Question 45

Which of the following is known as the Medicare Supplemental Insurance?

A) Work Opportunity Reconciliation Bill
B) Personal Responsibility and Work Opportunity Reconciliation Act
C) Programs of All-Inclusive Care for the Elderly
D) Medigap

Question 46

Most preferred provider organizations (PPOs) cover visits to the physician, well-baby care, immunizations, and mammograms, all of which are considered:

A) altruistic care.
B) preventive care.
C) administrative care.
D) constructive care.

Question 47

What does TANF stand for?

A) Tangible Assets for New Families
B) Temp Agency for Needy Families
C) Temporary Assistance for Needy Families
D) Temporary Activities for Neglected Families

Question 48

Fee-for-service plans are the traditional type of healthcare policy. The client determines a price for each type of service delivered, and then the insurance company pays the fee.

Question 49

The Medicare system is based on fee-for-service for paying physicians. Medicare pays an individual physician an amount that does not exceed the 75th percentile of charges by all physicians in a community.

Question 50

A preferred provider organization is a combination of traditional fee-for-service and an HMO. Similar to an HMO, clients use the physicians and hospitals that have agreed to give discounts to their insurer.

Question 51

Medicare Part A coverage is generally provided automatically and free of premiums to persons age 65 or over who are eligible for Social Security or Railroad Retirement benefits, whether they have claimed these monthly cash benefits or not.

Question 52

Medicare Part D coverage provides subsidized access to prescription drug insurance coverage on a voluntary basis upon payment of a premium.

Question 53

The Balanced Budget Act included a state option known as Programs of All-Inclusive Care for the Elderly (PACE).

Question 54

The main function of the Affordable Care Act is to produce private health insurance exchanges in every state. These exchanges will serve as a marketplace for consumers, offering local, standardized healthcare plans from a variety of providers.

Question 55

The United States spends a great deal of money on acute care and insufficient amounts on the promotion of health and prevention of diseases.

Question 56

People in higher income households are more likely than those in lower income households to report their health status as fair or poor

Question 57

The concept of insurance is to combine the healthcare experiences of many enrollees in order to reduce expenses for any one individual to a manageable prepayment amount.

Question 58

Employment-based health insurance is coverage offered through one's own employment or a relative's employment. It may be offered by an employer or by a union.

Question 59

Medicaid provides health care services for children under the age of 10.

Question 60

Individual practice association (IPA) is a type of healthcare provider organization composed of a group of independent practicing physicians who maintain their own offices and band together for the purpose of contracting their services to HMOs.