Question 1

Brittany and Brandon are both charged $250 for an office visit to the same specialist.Brittany's reimbursement policy has a deductible of $300.Once she has met the deductible,the policy will cover the full cost of her visits.Brandon's indemnity policy will pay him $150,the maximum amount his plan provides for a visit to any specialist.Which of the following is correct?

Accepted Answer

Brittany will have to pay the full $250 since she has not met her $300 deductible. Brandon's indemnity policy will cover a maximum of $150, so he will have to pay the remaining $100 out of pocket. Therefore, Brandon will have part of his bill paid by his policy, while Brittany will have to pay her entire bill.

Question 2

Jack needs comprehensive medical coverage; however,his income is quite low.What plan should he investigate?

Accepted Answer

Medicaid is a government program that provides comprehensive medical coverage to individuals and families with low incomes. Jack may be eligible for Medicaid based on his income level.

Question 3

Which of the following is NOT a private health care plan?

Accepted Answer

Medicare is a government health program.

Question 4

Xavier's employer offers a health plan that stresses preventive services and covers routine immunizations and checkups,screening programs,and diagnostic tests.What kind of plan does his employer offer?

Accepted Answer

HMO plans typically prioritize preventive services and may cover routine immunizations, checkups, and screenings. They may also have lower out-of-pocket costs for these services compared to other types of plans.

Question 5

Blue Cross and Blue Shield are

Accepted Answer

Blue Cross and Blue Shield are known as hospital and medical service plans, providing health insurance coverage for a variety of medical services.

Question 6

This type of plan combines features of HMOs and PPOs.It uses a network of participating physicians and medical professionals who have contracted to provide services for certain fees.

Accepted Answer

The option that describes a plan combining features of HMOs and PPOs is a Point-of-service plan (POS). It works via a network of contracted physicians and medical professionals who offer services at predetermined fees. POS plans enable members to select in-network or out-of-network healthcare providers, with higher out-of-pocket costs applying for out-of-network care. This blend of features is what makes the POS a hybrid of the HMO and PPO models.

Question 7

Which of the following is most likely to use a health maintenance organization?

Accepted Answer

Health maintenance organizations (HMOs) are often chosen by families who need regular, preventive care like annual checkups, as they typically offer lower premiums and focus on preventive services.

Question 8

Medicare (Part A)covers

Accepted Answer

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. It does not cover routine checkups, most immunizations, or dental care.

Question 9

Anna contributes pretax dollars to an account managed by her employer for her health care expenses.If she does not spend all of her money by the end of the year,she may forfeit it.What kind of plan does she have?

Accepted Answer

An FSA (Flexible Spending Account) is a type of employer-sponsored benefit plan that allows employees to contribute pretax dollars towards eligible health expenses. The money must be used by the end of the plan year, or else it is forfeited. This is different from an HRA (Health Reimbursement Arrangement) or HSA (Health Savings Account), which allow unused funds to roll over to the next year or be carried forward. Medicare is a federal health insurance program for those age 65 and older, while a self-funded health plan is a type of plan where the employer assumes the financial risk for providing health care benefits to employees.

Question 10

Who is most likely to use a home health care agency?

Accepted Answer

Home health care agencies typically provide services for the elderly or disabled individuals who need assistance with daily living activities.

Question 11

A Medigap policy fills the gap between medical costs and medical payments from

Accepted Answer

Medigap policies are designed to supplement and fill the gaps in coverage left by Original Medicare (Parts A and B). These policies are sold by private insurance companies and work alongside Medicare to pay for certain out-of-pocket expenses such as deductibles, copayments, and coinsurance.

Question 12

A provision in a health insurance policy that will cover only a fixed amount for an expense is called

Accepted Answer

An internal limit is a provision in a health insurance policy that will cover only a fixed amount for a specific expense. This limit is an agreement between the insurance company and the policyholder, usually stated in the policy agreement. In contrast, a deductible is an amount the policyholder is responsible for paying before insurance coverage begins, and an out-of-pocket limit is the maximum amount the policyholder will have to pay for covered expenses during a plan year. Reimbursement and indemnity are terms more generally associated with how the insurance company pays for covered expenses, rather than a specific provision in a policy.

Question 13

Jacob is concerned that his out-of-pocket health care expenses will be quite high,so he is considering adding contributions to a tax-free account that he can use with his high-deductible policy to cover catastrophic expenses.What kind of plan does he have?

Accepted Answer

Jacob is considering adding contributions to a tax-free account that he can use with his high-deductible policy to cover catastrophic expenses. This is a description of a Health Savings Account (HSA). Both FSAs and HRAs are also tax-free accounts that can be used to cover health care expenses, but they are not typically paired with high-deductible health plans. Medicare and self-funded health plans also do not fit the description provided.

Question 14

A quality health insurance plan should do all of the following except

Accepted Answer

A lifetime maximum level of coverage of $50,000 is not sufficient for quality health insurance coverage as it may not cover expensive treatments or long-term care. A quality health insurance plan should offer a higher lifetime maximum level of coverage to ensure comprehensive coverage for individuals. The other options (A, B, C, and D) are all important factors for a quality health insurance plan.

Question 15

Individuals over the age of 65 who are eligible for federal government health plan coverage may also be interested in purchasing more coverage called

Accepted Answer

Individuals over the age of 65 who are eligible for federal government health plan coverage through Medicare may also choose to purchase Medigap, also known as Medicare Supplement Insurance. Medigap policies are sold by private companies and can help cover some of the out-of-pocket costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles. Medicaid is a separate government program for individuals with low income and limited resources, and Medicare Part A and B are components of the federal government health plan for seniors. Statewide health coverage is not a specific program or policy.

Question 16

Monica's employer offers a health insurance plan with a very high deductible.In addition,her employer provides a fund for her to spend specifically on health care.What kind of plan does she have?

Accepted Answer

Monica has a Health Reimbursement Arrangement (HRA) plan, where her employer provides a fund for her to spend specifically on health care. The high deductible means that she likely has a high-deductible health plan (HDHP), which is a requirement for having a Health Savings Account (HSA). However, since her employer is providing the funds, it is not an HSA plan. An FSA would also provide funds for health care but is typically funded by the employee, not the employer. Medicare is a government-sponsored health insurance program for those over 65 or with certain disabilities. A self-funded health plan is a plan where the employer takes on the risk of providing health insurance to employees, which does not necessarily indicate the type of account funding.

Question 17

Medicaid covers

Accepted Answer

Medicaid covers lab services, skilled nursing and home health services, prescription drugs, and eyeglasses, as well as many other healthcare services and treatments.

Question 18

Yvonne's employer offers a health plan that has a group of doctors and hospitals that agree to provide specified medical services to members at prearranged fees.This health plan offers some flexibility since members can either visit a physician from a list or go to their own doctors.What kind of plan does her employer offer?

Accepted Answer

The health plan offered by Yvonne's employer is a Preferred Provider Organization (PPO), which offers a network of healthcare providers at prearranged fees but also allows members to visit their own doctors outside the network. This is different from a Health Maintenance Organization (HMO), which requires members to choose a primary care physician within the network and typically does not cover out-of-network care except in emergencies.

Question 19

The set amount that you must pay toward medical expenses before the insurance company pays benefits is called

Accepted Answer

The set amount that you must pay toward medical expenses before the insurance company pays benefits is called a "deductible".

Question 20

After you have reached a certain limit that you must pay for the deductible and coinsurance,the insurance company covers 100% of any additional cost.This is called

Accepted Answer

The out-of-pocket limit is the maximum amount of money an insured individual will pay for covered medical expenses in a benefit period. Once this limit is reached, the insurance company covers 100% of any additional costs. This is also known as the annual maximum out-of-pocket or catastrophic cap.

Quiz 9: Health and Disability Income Insurance