Econ Chapter 9

what percent does administrative costs represent in health care dollars in the US

26%

good insurance pays what percent after the deductible has been met

80%

part __ of medicare covers all services for inpatient hospital care after you pay a single deductible

A

___ is a health insurance plan that provides a wide range of health care services for a fixed, prepaid monthly premium

HMO (health maintenance organization)

___ is the world's most extensive collection of published medical info, originally for health professionals

MEDLINEPlus

are like HMOs except the networks are managed by groups of doctors and hospitals and they offer members greater flexibility by allowing members to go to a preferred provider or to their own physician

PPO's

what is a provision under which an insured pays all costs up to a certain amount, then the insurance company pays 100% of remaining bill

a stop-loss provision

what leads to increased health care costs?

added use of technology, use of prescription drugs, life expectancy of elderly, and accidents/crimes

eligibility is determined by

age, sex, and marital status

___ are limits on the entire dollar amount of coverage

aggregate limits

these are factors that have increased health care costs

aging population, cost of prescription drugs, and an increased amount of uninsured people

you ___ you sign a paper allowing insrance company to make payments directly to hospital or ddoctor

assign benefits

____ defines the max benefits possible in terms of dollar amount or number of days spent in the hospital

benefit limits provision

is an independent, nonprofit membership corporation that provides protection against the cost of health care

blue cross

__ is an independent nonprofit membership corporation that provides benefits for surgical and medical services

blue shield

a disability plan should pay you when you:

can only work part time are your regular job and are unable to work your regular job

why are administrative costs higher in US than other nations?

checking eligability, filing reimbursment clains, enrolling beneficiaries in health plan, and paying health insurance premiums

comprehensive major medical insurance offers:

complete insurance policies with a small deductible

provision where the insured pays a flat dollar amount each time a covered medical service is received after the deductable has been met is a

copayment

what does long-term care provide?

daily help

___ is the amount the policy holder must pay before benefits become payable by the insurance company

deductible

how should you evaluate long-term insurance?

does the policy have a max lifetime benefit, how much does the policy pay each day, is the policy guaranteed renewable

this insurance is considered to have poor value

dread disease insurance

HMO basic services for in and out patient are:

emergency care, surgery, and hospitalization

who pays for the cost of health care in group health insurance plans?

employers and employees

under which policy is the insurance company not allowed to raise premiums unless it raises them for the hole group?

guaranteed renewable policy provision

___ is a form of protection to alleviate the financial burden individuals suffer from illness or injury

health insurance

this is a plan funded solely by employers and gives a pool of money to spend on health care and have high deductible policies and based on actual expenses incurred

health reimbursement account

___ accounts allow you to contribute money to a tax-free account that can be used for out of pocket health care expenses as long as you have insurance policies to cover catastrophic expenses

health savings

___ has links to 1,000 websites operated by gov't and non-profit organizations

healthfinder

policy that pays benefits when you are hospitalized that are in cash and you can spend how you choose?

hospital indemnity policy

health insurance is one way people protect themselves again economic losses due to:

illness, accident, and disability

health care professionals and consumers have done what to keep down overall cost of health care?

incentives to enourage preventitive care, community health planning, and community health edu programs

___ provides specified benefits regardless of whether the actual expenses are greater or equal than the benefits

indemnity

specifically what does the basic HMO plan include?

inpatient, outpatient, maternity, mental health, substance abuse, rehab, and emergency care

what benefits are covered under physician expense insurance?

lab tests, xrays, doctors fees for non surgical care

this pays most of the costs exceeding those covered by the hospital, surgical, and physician expense policies

major medical expense insurance

___ refers to prepaid health plans that provide comprehensive health care to members

manage care

___ are prepaid health plans that provide comprehensive health care to members

managed care

which program provides medical assistance to low income individuals?

medicaid

is financed from a portion of social security taxes

medicare hospital insurance

this supplements medicare by filling the difference between medicare payments and medical costs not overed by medicare

medigap insurance

why are providers preferred over HMOs?

more flexibility and choice of physician

who provides group health insurance plans through the employers?

most private insurance companies

what is a point of service plan?

network of selected contracted participating providers. also called an HMO-PPO hybrid

which part of Medicare is voluntary and covers prescription drugs?

part D

hospital expense insurance pays

part or all of hospital bills for room, board, and other charges

HMO services include:

periodic check ups, diagnostic testing, immunizations, and screening programs

what is basic health insurance a combo of? (3 types of insurance)

physician expense insurance, surgical expense insurance, and hospital expense insurance

in ___ plans, they reimburse expenes for out of plan providers, but the outside network it costs much more

point-of-service (POS)

who offers managed care?

point-of-service plans, preferred provider orgz, and heal maintenance orgz

_____ is a group of doctors and hospitals that agree to provide health care to members at prearranged fees

preferred provider organization

similar to car and life insurance, person pays a ___ for health insurance

premium

what is the purpose of the statement "reasonable and customary"

prevent overcharging

Part C Medicare is run by...

private health care providers

___ policy provides benefits based on actual expense

reimbursement

what did the health insurance portability and accountability act of 1996 do?

set new standards so workers would not lose health insurance if they switched jobs and allows parents with sick kids to switch health insurance without paying more than other employees

what affects cost of health insurance the most?

size of deductible and amount of coinsurance

what isn't covered by medicare?

some types of dental, private-duty bursing care, and most immunizations

who funds medicaid?

state and federal funds

disability benefits should equal 70-80% of what

take home pay plus other sources of income

who pays large portion of health insurance bill?

third parties, private health insurers and the gov't

what are spplemental health services for an HMO?

vision and pharmaceutical services

out of pocket limit increases

your premium