Global Exam 3

In order to reduce which of the following, there is as much as a 10 percent per year financial penalty for failing to enroll in Medicare Part B immediately upon eligibility? A. Adverse selection B.Moral hazard C. Utilization review D. Risk aversion

A. Adverse selection

The most recent failed health reform effort had been under what president using a process that was criticized as slow, secretive, and overly ambitious? A. Bill Clinton B. George W. Bush C. Ronald Reagan D. Jimmy Carter

A. Bill Clinton

Which of the following provisions went into effect in 2010? A. Coverage of dependents until the age of 26 B. Individual mandate C. Establishment of health insurance marketplaces D. Optional expansion of Medicaid eligibility to cover more low-income adults

A. Coverage of dependents until the age of 26

Which of the following protects multistate employers from facing inconsistent obligations in different states so that they may offer employees working in different states the same package of health benefits? A. Deemer Clause B. Commerce Clause C. Guarantee Clause D. Loyalty Clause

A. Deemer Clause

The benefits of smaller hospitals joining integrated delivery system include: A. Financial protection B. Immediate improvement in cash flow C. Debt forgiveness D. Creative financial planning

A. Financial protection

Title XVIII of the Social Security Act is commonly known as which of the following? A. Medicare B. Medicaid C. TRICARE D. SCHIP

A. Medicare

Community and Migrant Health Centers C/MHCs are best known for which of the following? A. providing quality services to low income and vulnerable populations B. limiting the number of consumers seen in order to decrease cost C. Providing primary care directly proportional to their budget D. Providing access to speciality services

A. providing quality services to low income and vulnerable populations

The ACA requires the establishment of "exchanges," which are: A. state-based marketplaces where consumers can obtain ACA-compliant health plans. B. subsidies to purchase private health insurance. C. government-based marketplaces for Medicaid coverage. D. open enrollment periods during which individuals can purchase health plans.

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

Prior to the Affordable Care Act, approximately what percentage of the population was uninsured? A. 15 percent B. 16 percent C. 17 percent D. 18 percent

B. 16 percent

An Institute of Medicine (IOM) research study estimates that the average number of patients in the U.S. who die as a result of medical errors is: A. 44,000 B. 71,000 C. 80,000 D. 98,000

B. 71,000

The overall life expectancy in the US is: A. 85 B. 80 C. 75 D. 70

B. 80

Which of the following is not a tool used by all managed care plans to reduce spending? A. Apply out-of-pocket costs B. Contract with providers C. Require the use of a primary care gatekeeper D. Limit coverage for some types of procedures

B. Contract with providers

Health insurance's original function was to protect against: A. unavoidable, unpredictable illness B. Costly, unpredictable medical bills C. costly, unavoidable poor health D. avoidable, unpredictable bankruptcy

B. Costly, unpredictable medical bills

Under which piece of legislation are self-insured plans exempt from many of the state regulations for fully insured plans, an important exemption for employers operating in multiple states? A. Wagner Act B. Employee Retirement Income Security Act C. Medicare Modernization Act D. Patient Protection and Affordable Care Act

B. Employee Retirement Income Security Act

Enrollees who are encouraged to use more care or behave recklessly simply because they have insurance is a phenomenon known as which of the following? A. Adverse selection B. Moral hazard C. Utilization review D. Risk aversion

B. Moral hazard

The Affordable Care Act is based on which of the following premises? That... A. If you pass the legislation and offer the plan, consumers will utilize the services B. People with PCPs are more likely to receive preventive care, and are more satisfied C. Insurance companies are not consumer friendly D. Most consumers really cannot afford health insurance

B. People with PCPs are more likely to receive preventive care, and are more satisfied

Under what piece of legislation were workers guaranteed the right to collectively bargain for benefits, allowing health insurance to become an integral part of employees' compensation packages? A. New Deal B. Wagner Act C. Social Security Act D. Patient Protection and Affordable Care Act

B. Wagner Act

An additional cost that the insurer charges to administer claims and make a profit is known as: A. Actuarially fair premium B. loading charge C. Copayment D. Deductible

B. loading charge

According to the US Census Bureau, the number of uninsured in the US rose to more than: A. 38 million B. 45 million C. 50 million D. 60 million

C. 50 million

Setting premiums based on average healthcare spending in the area is known as: A. indemnities B. experience rating C. Community rating D. Service benefits

C. Community rating

The Indian Health Service, an agency under which federal agency, provides healthcare services to over 2 million federally recognized American Indians and Alaskan Natives and their descendants? A. U.S. Food and Drug Administration B. Centers for Disease Control and Prevention C. Department of Health and Human Services D. National Institutes of Health

C. Department of Health and Human Services

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? A. Guaranteed issue B. Pay-or-play mandate C. Individual mandate D. Guaranteed renewability

C. Individual mandate

Which of the following statements is true about the rules for private health insurance prior to the Affordable Care Act? A. Insurers were required to offer insurance to individuals with a preexisting health issue. B. Insurers were required to offer essential health benefits. C. Insurers were allowed to raise premiums without justification. D. Insurers were banned from setting lifetime limits.

C. Insurers were allowed to raise premiums without justification.

Together, what two programs are the largest health insurance programs in the United States? A. Medicare and Medicaid B. Medicare and SCHIP C. Medicaid and SCHIP D. Medicaid and TRICARE

C. Medicaid and SCHIP

What piece of legislation authorized the creation of health savings accounts into which an employer or employee could contribute tax-free dollars for out-of- pocket payments related to such a plan? A. Wagner Act B. Social Security Act C. Medicare Modernization Act D. Patient Protection and Affordable Care Act

C. Medicare Modernization Act

What part of Medicare, also known as Medicare Advantage, is a set of managed care options that are privately offered as an alternative to traditional Medicare? A. Part A B. Part B C. Part C D. Part D

C. Part C

Which of the following is a major criticism of the Affordable Care Act? A. It extends coverage up to 35 B. It does not cover the costs for immunizations C. People are not covered after age 26 D. A person can longer chose their physicians

C. People are not covered after age 26

According to the Affordable Care Act, which of the following groups of people are not required to obtain health insurance? A. Members of Congress B. People who are formerly incarcerated C. People who cannot afford coverage D. People who went without insurance for fewer than 6 months

C. People who cannot afford coverage

ERISA treats what type of plans not as insurance, but as administrative contracts between employers and insurers? A. Fully insured plans B. Government-sponsored plans C. Self-insured plans D. Grandfathered plans

C. Self-insured plans

Which of the following is not a requirement under the Affordable Care Act? A. Individuals must purchase insurance. B. Large employers must offer insurance or pay to cover premiums for insurance purchased outside of the workplace. C. States must expand Medicaid coverage to everyone under 138 percent of the federal poverty level. D. States must have a virtual health insurance marketplace.

C. States must expand Medicaid coverage to everyone under 138 percent

Which of the following was implemented in 1966 and provides healthcare benefits for all seven uniformed services? A. Medicare B. Medicaid C. TRICARE D. SCHIP

C. TRICARE

Which of the following statements is true of the Affordable Insurance Exchange? A. American citizens and legal immigrants who are already covered can use this to cover gaps in their existing plan. B. Individuals who do not have coverage can petition the government for permission to obtain coverage through this exchange. C. The Exchange is available to small businesses with fewer than 100 employees. D. Individuals and businesses using the Exchange will not qualify for additional tax credits.

C. The Exchange is available to small businesses with fewer than 100 employees.

To qualify for subsidies on health insurance marketplaces, consumers must earn an income between _____ percent and _____ percent of the federal poverty level. A. 0; 138 B. 100; 138 C. 100; 250 D. 100; 400

D. 100; 400

People eligible for COBRA may buy into their former plan for what time period, depending on the reason for the loss of access? A. 3-6 months B. 6-12 months C. 12-18 months D. 18-36 months

D. 18-36 months

From which of the following regulations are self-insured and grandfathered plans exempt? A. Dependent coverage until the age of 26 B. Summary of Benefits and Coverage document must be offered C. Lifetime limits on coverage for essential health benefits D. Coverage of preventive services

D. Coverage of preventive services

Which of the following is a type of managed care plan characterized by restrictive networks, limited out-of- network benefits, and fee-for-service physician payment methods? A. Health maintenance Organizations (HMOs) B. Preferred provider organizations (PPOs) C. Point-of-Service (POS) plans D. Exclusive provider organizations (EPOs)

D. Exclusive provider organizations (EPOs)

What type of plans are exempt from a host of ACA regulations, including guaranteed issue and renewability and modified community rating? A. Fully insured plans B. Government-sponsored plans C. Self-insured plans D. Grandfathered plans

D. Grandfathered plans

Workers and hospitals relied on each other to endure the financial devastation of what event, which further entwined employment with health insurance? A. World War I B. World War II C. Prohibition D. Great Depression

D. Great Depression

Which of the following provisions of the Affordable Care Act requires most insurers to offer coverage to all applicants regardless of health status? A. Individual mandate B. Employer mandate C. Guaranteed renewability D. Guaranteed issue

D. Guaranteed issue

During the Great Depression, employees joined the first integrated prepaid groups plans, which would later develop into which of the following? A. preferred provider organizations B. Exclusive provider organizations C. Indemnity plans D. Health maintenance organizations

D. Health maintenance organizations

Which of the following best reflects care delivery in the US? It is primarily: A. Primary Care B. Community-based C. Outpatient-based D. Hospital-based

D. Hospital-based

It is suggested that the US government could save as much as $100 billion dollars a year by doing which of the following ? A. Decreasing Medicaid costs B. Decreasing Medicaid and Medicare costs C. Eliminating the medicaid program D. Lowering administrative costs

D. Lowering administrative costs

Two government-sponsored health insurance programs developed in the 1960s were: A. HMOs and Medicare B. PPOs and HMOs C. BLue Cross and Medicare D. Medicare and Medicaid

D. Medicare and Medicaid

To make coverage more affordable for the sickest individuals, the ACA adopted which of the following? A. Experience rating system B. Community rating system C. Modified experience rating system D. Modified community rating system

D. Modified community rating system

Prior to what option, beneficiaries lost their TRICARE coverage when they reached age 65? A. TRICARE Standard B. TRICARE Extra C. TRICARE Prime D. TRICARE for Life

D. TRICARE for Life

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

False

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

False

True or False. COBRA is an affordable solution to health insurance coverage when individuals lose their coverage through an employer.

False

True or False. Capitation is a form of payment where providers pay a negotiated fee for service.

False

True or False. During the early 1990s, the US healthcare system was primarily ruled by physicians.

False

True or False. Employer and employee premium contributions to the employee's health insurance plan are subjected to federal and state income taxes, as well as Social Security and Medicare payroll taxes.

False

True or False. Like the individual marketplace, there is a defined open enrollment period in the SHOP marketplace.

False

True or False. Medigap policies are offered through public health insurers and are not private health insurance.

False

True or False. Most comprehensive health insurance plans do not qualify as minimum essential coverage.

False

True or False. Partly because of major medical advances, life expectancy in the US is higher than most industrialized countries.

False

True or False. People with end-stage renal disease or amyotrophic lateral sclerosis are eligible for Medicaid as soon as they begin receiving SSDI payments.

False

True or False. Point-of-service plans are more restrictive than an HMO but less restrictive than a PPO.

False

True or False. The U.S. has one of the lowest infant mortality rates in the industrialized world

False

True or False. The US enjoys one of the best infant mortality rates in the industrialized world.

False

True or False. Traditional indemnity insurance for healthcare expenses remains as a large proportion of the health insurance market.

False

True or False. Although states have some flexibility in designing benefits for Medicaid recipients, every state Medicaid program must offer certain basic services to receive federal funding.

True

True or False. Employer and employee premium contributions to employee's health insurance plans are exempt from federal and state income taxes, as well as Social Security and Medicare payroll taxes.

True

True or False. Experience rating sets lower premiums for healthy, low-risk subscribers and higher premiums for sicker, high-risk subscribers.

True

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

True

True or False. In an attempt to prevent adverse selection, many insurers previously limited coverage for preexisting conditions.

True

True or False. Most Medicare beneficiaries with annual incomes above $20,000 either rely on employer-provided health benefits to supplement Medicare or they purchase Medigap health insurance to fill in for limits on covered benefits.

True

True or False. People in low-income households are more likely to have government coverage than people in higher- income households.

True

True or False. TRICARE generally does not cover services and supplies that are not medically or psychologically necessary for the diagnosis or treatment of an illness, injury, or treatment of pregnancy or well-child care.

True

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

True

True or False. The Patient Protection and Affordable Care Act was a landmark piece of legislation intended to expand coverage among nonelderly adults.

True

True or False. The Wagner Act of 1935 guaranteed workers the right to collectively bargain, leading to health insurance as an integral part employees' compensation packages.

True

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

True

True or False. While ERISA preempts most state laws regarding employee benefits, it does not preempt state law for health insurance.

True

True or False. While individuals and smaller employers pay insurers to take on the risk of illness or injury, self-insured employers take on this risk themselves.

True

True or false. Managed care's success in lowering healthcare spending and the price of insurance was undermined by the consolidation of providers.

True

True or false. The Clinton healthcare reform can be accurately described as a universal health plan.

True