Global exam 4

Prior to the ACA, federal law included some benefit mandates, but they applied only to plans that covered certain services.

True

To qualify for subsidies on health insurance marketplaces, consumers must earn an income between _____ percent and _____ percent of the federal poverty level.

100; 400

In 2014, a point-in-time estimate for the number of people uninsured is about what percent of the population?

12%

States may not charge premiums to Medicaid enrollees who qualify for the program with incomes below what percentage of the federal poverty level (FPL

150%

Prior to the Affordable Care Act, approximately what percentage of the population was uninsured?

16%

n what year was a federal, enforceable patients' bill of rights passed into law?

2010

Under the ACA, all new plans must cover preexisting conditions, certain preventive services, and—for plans with dependent coverage—dependent children up to what age?

26 years

All silver plans on the health exchanges must have actuarial value of what percentage, meaning they must cover that percentage of healthcare costs among enrollees in that plan?

70%

What piece of landmark legislation included the first federal patient bill of rights?

ACA

In 1973, what organization outlined the first patient bill of rights, incorporating patient opinions and institutional policies about informed consent and patient autonomy?

AMerican Hospital Association

Which of the following, in which drugs used to treat high-cost conditions are systematically placed in high cost-sharing tiers, is generally prohibited by the ACA?

Adverse tiering

Which of the following is not a reason that estimates of the uninsured differ?

All are correct

What agency helps patients who feel their HIPAA right have been violated and offers forms and local contact information for reporting violations?

American Hospital Association

In 1997, what U.S. president appointed the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry to draft a patient bill of rights?

Bill Clinton

The most recent failed health reform effort had been under what president using a process that was criticized as slow, secretive

Bill Clinton

The price of what type of drugs has become so high that some insurers have added a fifth and even a sixth tier to their formularies?

Biologics

Which of the following provisions went into effect in 2010?

Coverage of dependents until the age of 26

From which of the following regulations are self-insured and grandfathered plans exempt?

Coverage of preventative service

The most commonly cited estimate of the uninsured is from which of the following surveys?

Current population study

What survey, focusing on employment, has the most commonly cited estimate of the uninsured in part because it collects information from among the largest number of respondents?

Current population survey

What piece of legislation sets minimum standards for health insurance provided by private industry?

ERISA

Because tiered pharmacy benefit designs encourage the use of high-cost drugs, they also encourage the enrollment of high-risk consumers.

False

Both Democrats and Republicans supported the final version of the Affordable Care Act.

False

Like the individual marketplace, there is a defined open enrollment period in the SHOP marketplace

False

Many private health insurers model their coverage and reimbursement decisions after the Medicaid program

False

Most comprehensive health insurance plans do not qualify as minimum essential coverage

False

Only a flexible spending account may be set up without an employer and is "portable," in that the employee owns it and may take it from job to job or into and out of employment.

False

Patient advocates are made available only to patients upon discharge from the hospital.

False

Physicians were receptive to the Bipartisan Patient Protection Act because it would decrease malpractice litigation and enhance their autonomous practice

False

Prior to the ACA, sick and high-risk individuals without access to group insurance through an employer or the government had many options for affordable coverage.

False

Since changes to the Medicare program often influence the benefits that private insurers offer and the prices they pay, plans are required to align their policies with Medicare

False

The Emergency Treatment and Active Labor Act (EMTALA) restricts hospitals and providers from billing uninsured consumers for services as well as turning them away from the hospital.

False

The Patient's Bill of Rights was a piece of legislation that was voluntarily adopted by all covered entities and used as a framework by states that passed a state-level bill of rights into law.

False

The main reason people do not have health insurance is because some people believe they will not get sick.

False

The purpose of the drug formulary is to steer consumers to the most expensive drug option.

False

True or False? After the Affordable Care Act, insurers are allowed to vary premiums by family size

False

Under the ACA, preexisting conditions may be excluded from coverage, and premiums are calculated according to average risk in the community rather than individual risk.

False

While there are several reasons why people do not have health insurance, the most common reason is unemployment.

False

nsurance contracts generally agree to pay 100 percent of the medical cost without sharing costs with enrollees.

False

Which of the following pays the enrollee directly to assist with out-of-pocket payments for medical care?

Fixed-benefit indemnity insurance

In a classic four-tier formulary, the first tier contains the lowest copayment for what type of drugs?

Generic drugs

What type of plans are exempt from a host of ACA regulations, including guaranteed issue and renewability and modified community rating

Grandfathered plans

Which of the following provisions of the Affordable Care Act requires most insurers to offer coverage to all applicants regardless of health status?

Guaranteed issue

What piece of legislation is so named because it makes it easier to change jobs by limiting exclusions of preexisting conditions but is better known for its privacy protections?

HIPAA

n 1974, what state enacted the Prepaid Health Care Act, which required employers to offer health insurance to all employees who work over 20 hours per week?

Hawaii

Enrollees in HDHPs are also entitled to enroll in which of the following, which is an account owned by the enrollee into which he or she may contribute tax-free dollars to spend on cost-sharing, including deductibles, copayments, and coinsurance?

Health Savings Accounts

In practice, which of the following appeals to consumers who do not expect to use much health care and thus do not need to spend their deductible?

High deductible health plans

Which of the following provides coverage only after consumers have spent sometimes thousands of their own money out of pocket?

High deductible health plans

Which of the following is defined as tiered networks where consumers pay less for providers noted for high-quality or high-value care?

High-performance network

Which of the following was included as part of the ACA to encourage the healthiest Americans to purchase insurance and spread the cost of premiums among those who were already part of the risk pool?

Individual mandate

Which of the following statements is true about the rules for private health insurance prior to the Affordable Care Act?

Insurers were allowed to raise premiums without justification

Which U.S. senator sponsored the Bipartisan Patient Protection Act, which would have strengthened consumer protections in managed care plans by amending two other pieces of legislation?

John McCain

In 2006, what state passed broad legislation expanding healthcare coverage, similar to the ACA, in which one study found improved credit scores and reduced household debt and personal bankruptcy

Mass

Medicare beneficiaries have a default option of traditional, fee-for-service Medicare Parts A and B but may choose to forgo this option for which of the following offered through the private market?

Medicare Part C

To make coverage more affordable for the sickest individuals, the ACA adopted which of the following

Modified community rating system

For enrollees, which of the following may offer lower premiums and out-of-pocket costs as a trade-off for restricted provider choice?

Narrow networks

Over half (54 percent) of the uninsured population work in full-time jobs.

True

What type of formulary is characterized by providing coverage for drugs not listed but at a higher copayment, similar to a medical plan with out-of-network benefits?

Open formulary

According to the Affordable Care Act, which of the following groups of people are not required to obtain health insurance?

People who can not afford coverage

Which of the following, in any insurance plan, is based on the riskiness of the insured group as well as the generosity of the benefits

Premium

Which of the following is defined as required approval before policyholders receive a covered benefit

Prior authorization

Which of the following is the inverse of a high deductible, with the insurer paying the initial cost-sharing for the service or product and the consumer paying for any remaining cost?

Reference pricing

In 2006, what city passed a pair of laws to expand health coverage to its residents and workers

San Francisco

ERISA treats what type of plans not as insurance, but as administrative contracts between employers and insurers?

Self-insured plans

Under the Emergency Medical Treatment and Labor Act, a hospital provider must do what to an uninsured patient experiencing an em

Stabilize and transfer and DO NOT restrict billing

Which of the following is when a patient must try other medications before receiving a more expensive drug?

Step therapy

Consumers have the right to negotiate which of the following with the out-of-network provider and their insurance company and may seek help from a patient advocate in order to avoid exorbitant costs?

Surprise medical bills

The state with the highest rate of uninsured is:

Texas

Which of the following states has the highest rate of uninsured?

Texas

Which of the following statements about the uninsured is not true?

The uninsured are more likely to accrue medical debt.

Benefit mandates often generate significant controversy and debate about the balance between comprehensiveness and the affordability

True

Coverage exclusions are services or products that are never covered by the plan, even when medically necessary

True

Despite the policies and protections that are now in place for patients, it is still largely the responsibility of patients to advocate for their own health

True

Doctors have the responsibility to help patients understand treatment options and must provide understandable information that meets patient education levels and language need

True

Drug formularies are set every year by the insurer but are subject to change during the year if new evidence emerges about new or current medications.

True

Employees have the right to file a whistleblower complaint against an employer that is not complying with the ACA

True

Employment-based private premiums are subsidized by a large tax loophole, while public premiums are subsidized by general revenues.

True

Grandfathered plans are exempt from a host of ACA regulations, including guaranteed issue and renewability and modified community rating.

True

Health insurance plans generally cover a comprehensive array of benefits because purchasing individual benefits piece by piece would lead to substantial adverse selection

True

In an open formulary, drugs not listed may still be covered but at a higher copayment.

True

Massachusetts's health reform in 2006 resulted in improved self-reported health for the previously uninsured.

True

New plans must offer some preventive services, like routine immunizations, without cost-sharing.

True

Since the uninsured do not have as much contact with the medical system, the insured accrue medical debt and report difficulty paying medical bills more than the uninsured.

True

Some of the protections included in the Affordable Care Act will not apply to those in grandfathered health insurance plans.

True

States have the option to implement their own state-level patients' bill of rights.

True

The ACA, or "Obamacare," was the most significant expansion of health insurance coverage since Medicare and Medicaid in 1965

True

The federal government provides subsidies to employer-sponsored insurance plans by exempting employer and employee premiums from taxation

True

The open enrollment period is an incentive to purchase coverage even before consumers become sick or injured.

True

The phenomenon of underinsurance may lead individuals to seek care in an inappropriately intensive setting.

True

The terms of coverage listed in the evidence of coverage or certificate of coverage constitute a health insurance policy.

True

Though health insurance in the United States is expensive, most public and private premiums are subsidized in some way.

True

Ultimately, it is the responsibility of patients to seek and receive the best care and treatment.

True

n 2014, as part of the Affordable Care Act, almost all Americans were required to have health insurance.

True

rue or False? Sometimes a hospital will agree to a lower cost if a patient can pay all remaining charges immediately.

True

Referral and prior authorization are two tools used for which of the following purposes?

Utilization management

What piece of legislation prevents employers from legally retaliating against complaints?

Whistleblower

The uninsured are disproportionately:

black and hispanic

The SCHIP program expands coverage to:

children whose parents' incomes are too high to qualify for Medicaid.

Which of the following can help patients make sure they are receiving the right care, get a ride home after a procedure, or understand a bil

patient advocates

The ACA requires the establishment of "exchanges," which are:

state based marketplaces where consumers can obtain ACA-compliant health plans