Health Insurance Unit

What is the goal of managed care?

The goal is to reduce the cost of medical expenses by maintaining a healthy lifestyle.

People who cannot afford health care services are more likely to become sick than those who can afford health care services.

True

Socio-economics shows that there is a link between poverty and poor health.

True

The cost-effectiveness for each type of managed care is different for every situation.

True

The rising cost of health care is good for the economy, but the expenses are a burden for most individuals and families.

True

The three basic types of managed care are Health Maintenance Organizations, Preferred Provider Organizations, and Point of Service.

True

With indemnity insurance, patients are reimbursed for medical expenses after out-of-pocket payments are made.

True

Medicaid

Medicaid is a need-based program that was designed by the federal government. Medicaid provides medical assistance to individuals and families who are "needy."

People receiving Medicare are required to pay a yearly deductible.

True

Daignostic

Diagnostic services include careers that involve evaluating the health status of patients at a single point in time.

Every low-income person is guaranteed medical assistance from Medicaid.

False

Insurance agencies must reimburse doctors for the full amount that was charged to the patient.

False

PPOs require the insured person to choose one primary care physician.

False

Medicare

For adults over 65 years old Entitlement program Administered by federal government

Medicaid

For needy families and individuals Administered by state government Need-based program

What is the concept of managed care?

Managed care is built on two primary concepts: to promote good health and to practice preventive medicine.

Gross National Product

Gross National Product (GNP) is the total amount spent on goods and services in one year.

POS

Point of Service, or POS

PCP

primary care physician, or PCP

Co-payment

A co-payment is an amount paid by the patient for a certain service, such as paying $15 for each doctor visit.

Physician

A physician is a licensed health care professional who examines patients, orders health screenings, makes diagnoses, prescribes medications, performs surgeries, and teaches preventative health.

Prescription

A prescription medication is a medication which people buy only with written authorization from a physician or dentist to a pharmacist.

System

A system is a group of individual parts that work together to form a unified whole.

Vaccine

A vaccine is a substance given to a person to produce immunity to a disease.

Out-of-Pocket

An out-of-pocket expense is a medical bill that must be paid by the patient. Many health insurance policies have a limit to the amount of out-of-pocket expenses to be paid by the patient during a year.

Why do HMOs encourage their clients to practice healthy lifestyles?

Because it is cheaper to prevent an illness than to treat an illness.

In which type of insurance policy is the premium split between an employer and the person being insured?

Group

Group insurance

Group insurance is generally purchased through an employer. The premium is split between the employer and the person being insured.

The insured person must receive medical treatment from a specific network of health care providers

HMO

What types of providers are there for managed care?

Health Maintenance Organizations Preferred Provider Organizations Point of Service

HMO

Health Maintenance Organizations, or HMOs, are a common type of managed care.

What type of care does Medicare Type A provide?

Hospital care

PPO

Preferred Provider Organization, or PPO, is another type of manage care.

indemnity insurance

In indemnity insurance, patients pay for health care expenses out-of-pocket. Afterward, the insurance agency will reimburse the patient for the expenses.

In which type of insurance policy does the person being insured pay the entire premium?

Individual

Individual insurance

Individual insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage.

Managed care

Managed care offers medical services at a reduced rate through a network of health care providers. Three types of managed care are HMOs, PPOs, and POS plans.

Medicare

Medicare is a program that is administered by the federal government. 65 or older, Medicare is also available to some people under the age of 65 with certain disabilities.

The insured person pays low co-payments and no deductible for in-network services.

POS

The insured person may chose between in-network or non-network health care providers. Reduced rates are given for in-network services.

PPO

Medicare: Part A

Part A: Hospital Care Hospitalization Skilled nursing facilities Home health care Hospice care Long-term care facilities

Medicare: Part B

Part B: Outpatient Services Medical expenses, including physician services, physical therapy, occupational therapy, speech therapy, medical equipment, and diagnostic testing Preventive care

Pediactric

Pediatrics is the study of diseases and disorders of children.

Rehabilitation

Rehabilitation is the restoration of a patient who has been debilitated by disease or injury to functional life.

What is the study of how economics is affected by society, culture, and politics?

Socio-economics

Socio-economics

Socio-economics is the study of how economics is affected by society, culture, and politics.

Who is in charge of Medicaid?

State government

What is a health insurance premium?

The amount paid to an insurance agency for an insurance policy

deductible

The deductible is the amount that must be paid by the patient before the insurance agency will begin making payments. Deductibles are paid on a yearly basis.

Deductible

The deductible is the amount that must be paid by the patient before the insurance agency will begin to make payments. Deductibles are paid on a yearly basis.

Premium

The premium is the amount paid to an insurance agency for a health insurance policy. The premium is often paid on a monthly basis.

What is the goal of managed care insurance?

To reduce medical expenses by maintaining healthy lifestyles

A deductible is paid on a yearly basis.

True

A person, who receives medical insurance from a PPO, may receive treatment from a non-network physician.

True

Anyone who must purchase medical insurance should research and compare the types of plans that are available.

True

Doctors may charge any amount for the services they provide.

True

Health insurance agencies do not always reimburse the full amount charged for services.

True

Health insurance policies may be purchased in two basic forms, individual and group.

True

In indemnity insurance, patients must pay for health care expenses out of their own pockets and then wait for reimbursement from the insurance agency.

True

In most POS plans, a deductible is not required for an in-network physician.

True

It is much cheaper to prevent an illness than to treat an illness.

True

Managed care plans offer medical services through a system of health care providers, who provide treatment at reduced rates.

True

Many HMOs require the insured person to select one primary care physician.

True

Medicaid is a needs-based program that provides medical assistance to individuals and families who are in need.

True

Medical insurance is an important benefit of employment.

True

Medicare is an entitlement program that provides medical assistance to anyone age 65 or older or to people with certain disabilities.

True