health insurance providers

what is medicare?

A hospital and medical expense insurance program

which of the following reimburses its insured covered for medical expenses

commercial insurers

A medical care provider which typically delivers health services at its own local medical facility is known as a

health maintenance organization

what does medicare parts a and b cover

part a hospitalization part b doctors services

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a

primary care physician

which of the following statements is true about most blue cross/ shield organizations

they are non profits

what is the maximum social security disability benefit amount an insured can receive

100% of the insured's Primary Insurance Amount (PIA)

medicare is intended for people who are

65 and older, afflicted with chronic kidney failure, receiving social security benefits for atleast 24 months

which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures

Commercial insurer

which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements?

HMO

J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a preset price. What type of plan does J belong to?

Health Maintenance Organization (HMO)

Which type of provider is known for stressing preventative medical care?

Health Maintenance Organizations (HMO's)

A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?

Her group health plan

the health insurance program which is administered by each state and funded by both the federal and state governments is called

Medicaid

which of the following best describes how a PPO is less restrictive than an HMO

More physicians to choose from

which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care

Obtain prior approval from the insurer for the medical service

Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?

PPO

the percentage of an individuals primary insurance amount determines the benefits paid in which of the following programs

Social Security Disability Income

Medicaid was designed to assist individuals who are

below a specific income limit

the situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called

closed panel

blue cross and blue shield are the

dominant insurers of the US

what is true regarding medicaid

it covers individuals and families with low income funded by state and federal governments