Question 1

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Accepted Answer

Most health insurance plans do not cover "elective" procedures.

Question 2

Individual health insurance plans cover only one person.

Accepted Answer

An individual health insurance plan is one that is not offered by an employer or another group. An individual policy can cover just one person or a family.

Question 3

The health insurance mode that offers the least flexibility for patients is

Accepted Answer

Health maintenance organizations (HMOs) offer the least flexibility for patients because they restrict patients to a network of healthcare providers and require a primary care physician to refer patients to specialists. This means patients have less choice in selecting healthcare providers and treatments.

Question 4

The allowed amount for Medicare charges is determined using

Accepted Answer

The allowed amount is determined using a resource-based relative value scale (RBRVS).

Question 5

RBRVS consists of three parts, including which of the following?

Accepted Answer

Implementation of the RBRVS in 1992 changed this system to a fee scale consisting of three parts:
• Provider work
• Charge-based professional liability expenses
• Charge-based overhead

Question 6

A provider can choose whether to accept Medicaid patients.

Accepted Answer

A provider may accept or decline to treat Medicaid patients. The provider can limit the number of Medicaid patients they accept, but cannot discriminate based on age, sex, race, religious preference, or national origin. The provider who accepts Medicaid patients automatically agrees to accept Medicaid payment as payment in full for covered services.

Question 7

TRICARE is a form of government insurance for veterans of the U.S. armed forces.

Accepted Answer

TRICARE is for active military, not veterans.

Question 8

There are no government managed care plans.

Accepted Answer

In an effort to reduce costs and increase the delivery of efficient care, Medicare and many Medicaid programs offer their members the option to join a managed care plan. These managed care plans must cover all services that would be covered under Medicare or Medicaid. The identification cards will look just like the ones issued to people not on Medicare or Medicaid. The government managed care plan may have a copayment that the patient would be responsible for.

Question 9

Which of the following services must be covered by Medicaid in each state?

Accepted Answer

In order to receive federal funds for Medicaid, each state Medicaid plan must cover the following services:
• Inpatient hospital services
• Laboratory and x-ray services
• Outpatient hospital services
• Family planning services
• Nursing facility services
• Nurse midwife services
• Early and periodic screening, diagnostic, and treatment (EPSDT) services
• Certified pediatric and family nurse practitioner services
• Home health services
• Freestanding birth center services
• Physician services
• Transportation to medical care
• Rural health clinic service
• Federally qualified health center services
• Tobacco cessation counseling for pregnant women

Question 10

The health insurance model that offers the most flexibility for patients is

Accepted Answer

Tradition health insurance plans provide the most flexibility for the patient, but are also the costliest option.

Quiz 23: Health Insurance Basics