Health Care Payment Systems All Quizzes

What is the best description of the factor or factors that determine Medicare eligibility? -Age-based -Categorical -Income based -Means-tested

Age-based

Which population was initially eligible for premium tax credits under the ACA? -Everyone at or below 138% FPL -People between 100-250% FPL -People between 0-400% of FPL -People between 100-400% of FPL

People between 100-400% of FPL

Which of the following are part of the "triple aim"? -Reducing per capita costs -Improving population health - A and B -None of these

A and B

What is an out-of-pocket max? -A cap on how much a given person must pay each month as a premium -A cap on the amount a beneficiary may have to spend out-of-pocket in a given year -A restriction on the amount of generic drugs a person can purchase in a given year -The level by which Medicaid cost-sharing is determined

A cap on the amount a beneficiary may have to spend out-of-pocket in a given year

What is a copayment? -A fixed dollar amount that a beneficiary pays for a given service or procedure at the point of service -The monthly payment made by an employee towards the full cost of their health insurance -The amount an employer pays towards an employee's yearly medical costs -A specific percentage of the cost for a service or procedure that is paid for by the beneficiary at the point of service

A fixed dollar amount that a beneficiary pays for a given service or procedure at the point of service

What is coinsurance? -A fixed dollar amount that is paid by the beneficiary at the point of service -When a person is covered by both Medicare and Medicaid -The monthly cost of an insurance plan -A percentage of the cost of a covered or procedure for which the beneficiary is responsible for paying at the point of service

A percentage of the cost of a covered or procedure for which the beneficiary is responsible for paying at the point of service

What is a death spiral? -A phenomenon in which Medicare's Trust Fund runs out of money due to too few tax-payers relative to Medicare beneficiaries -A phenomenon in which high premiums cause healthy beneficiaries to drop their insurance, which in turn causes premiums to increase, which in turn drives more healthy people from the insurance market, leading to market collapse -A phenomenon in which underinsured persons are bankrupted by medical debt -A phenomenon in which a state's health care system collapses because of the failure to expand Medicaid under the ACA

A phenomenon in which high premiums cause healthy beneficiaries to drop their insurance, which in turn causes premiums to increase, which in turn drives more healthy people from the insurance market, leading to market collapse

Guaranteed issue refers to a requirement in which insurance companies must do what? -Provide Medicare and Medicaid benefits in certain markets -Participate in health insurance exchanges -Spend a certain percentage of premium dollars on actual health care services -Accept all insurance applicants without regard to their health status or previous medical history

Accept all insurance applicants without regard to their health status or previous medical history

What terms is used to describe a phenomenon in which less healthy people disproportionately enroll in a given risk pool? -Adverse Selection -Bad luck -Premium Subsidies -Moral Hazard

Adverse Selection

What are among the key differences between Traditional Medicare and Medicare Advantage? -Medicare Advantage often covers hearing, dental, and vision, which TM does not -Medicare Advantage has an out-of-pocket maximum and TM does not -Generally, TM offers more flexibility to beneficiaries when seeking care with different providers -All of the above

All of the above

Which of the following contributed to the growth of private insurance in the United States? -Health insurance benefits are provided to employees tax free -Employers used benefits such as health insurance to attract and maintain employees -Providers promoted private insurance as an alternative to government-sponsored insurance -All of the above

All of the above

Which of the following factors can be used to determine the price of a monthly premium for a plan sold in the health insurance exchanges? -Age -Tobacco Use -Geographic location -All of the above

All of the above

Which of the following is TRUE about Medicaid? - Eligibility is means-tested and categorical -All of the above -Benefits vary from state-to-state -Eligibility varies from state-to-state

All of the above

Which of the following is true about the ACA's Health Insurance Exchanges? -Plans sold in the health exchanges must offer a set of essential health benefits -There are no annual or life-time limits on the dollar value of coverage for plans sold in the health insurance exchanges -Some people are eligible for subsidies to pay the monthly premium of plans sold in the health insurance exchanges -All of the above

All of the above

Which of the following is TRUE about Medicare and Medicaid? -Both are entitlement programs -Eligibility is primarily age-based -Eligibility varies from state-to-state -Both programs are jointly funding by the states and the federal government

Both are entitlement programs

Medicare Part B includes which of the following types of cost-sharing? -Coinsurance -Copayments -Coinsurance and Deductible -Deductible

Coinsurance and Deductible

All states have expanded Medicaid under the ACA. T or F?

False

Doctors and hospitals were broadly supportive of efforts to create national health insurance in the United States. T or F?

False

Expanding health insurance will likely save money overall by reducing the use of emergency departments. T or F?

False

It is not possible for a person to be simultaneously covered by Medicare and Medicaid. T or F?

False

No aspect of Medicare is means-tested. T or F?

False

No state in the US currently operates on a global budget. T or F?

False

Under the No Surprises Act insurance must cover the entire cost when a patient is balance billed and the hospitals/providers are automatically paid the entirety of their billed cost. T or F?

False

Under the No Surprises Act, patients are protected from which of the following? -Unexpectedly being dropped by their insurance company -From being charged for services provided by out-of-network providers at in-network hospitals -From unnecessary hospital procedures -From unexpected premium increases

From unnecessary hospital procedures

When a hospital in a given geographic area receives a fixed amount of funding for a set amount o time to provide care to a specified population, that hospital is operating under what type of payment system? -Bundled Payment -Single Payer -Global Budget -Medical Loss Ratio

Global Budget

What are the primary mechanisms by which the ACA expanded access to health insurance? -Health Insurance Exchanges -Medicaid - Public Option -Health Insurance Exchanges and Medicaid

Health Insurance Exchanges and Medicaid

Theoretically, global budgets are meant to incentivize which of the following action(s)? -Generating revenue by seeing as many patients as possible -Maintaining a heavily active emergency department -Investments in prevention -Over utilization

Investments in prevention

Which of the following is TRUE about Medicare? -It includes long-term care coverage -Eligibility is categorical -It makes up a large portion of state budgets -It is a purely federal program

It is a purely federal program

Which of the following statements is true about Maryland's health payment system? -There is dramatic variation in the prices paid by private and public insurance programs -It operates as a single payer -Medicare, Medicaid, and private insurers all pay the same rates for hospital services -There is absolutely nothing special about Maryland

Medicare, Medicaid, and private insurers all pay the same rates for hospital services

Which part of Medicare covers inpatient hospital services? -Part D -None of the above -Part B -Part A

Part A

Which of the following could be an unintended consequences of price transparency? -People assume higher priced services are higher quality - and spending increases as a result -Too many services become "shoppable" -There are no downsides to price transparency -Hospitals stop taking Medicaid beneficiaries

People assume higher priced services are higher quality - and spending increases as a result

A primary strategy by which an insurance company can ensure a reasonably predictable and stable expected health care costs is: -Death Spiral -Health Maintenance Organization (HMO) -Pooling Risk -Medical Loss Ratio (MLR)

Pooling Risk

What is the term used to describe the population that a hospital is responsible for under a global budget? -Health population -Reference population -Assigned population -Geographic population

Reference population

On what plan is the ACA's tax credits based? -Cheapest Bronze plan -The Public Option -The Second Cheapest Silver Plan -The average cost of a gold plan

The Second Cheapest Silver Plan

Which of the following represent an obstacle to the success of price transparency? -The absence of data on quality -Too much hospital competition -Broad compliance with transparency regulations -All of the above

The absence of data on quality

What is a deductible? -A fixed dollar amount that is paid by the beneficiary at the point of service -The amount a beneficiary owes for covered services before the health insurance plan starts to pay -A cap on the amount a beneficiary may have to spend out-of-pocket in a given year -The ratio of dollars spent on care versus administrative fees or profits

The amount a beneficiary owes for covered services before the health insurance plan starts to pay

What is the Federal Medical Assistance Percentages (FMAP)? -The percentage of persons covered by both Medicare and Medicaid -The rate at which Medicare payments are made to providers -The minimum amount an insurer must spend on services -The rate at which the federal government's share of Medicaid costs is determined

The rate at which the federal government's share of Medicaid costs is determined

As initially enacted, the ACA's Medicaid expansion was required, but is now an optional population. T or F?

True

Hospitals are the largest source of health care spending in the United States. T or F?

True

Medicaid is jointly funded by the states and the federal government. T or F?

True

Medicaid relies heavily on managed care organizations to provide Medicaid benefits. T or F?

True

Medicare Part A has automatic enrollment and a relatively large deductible. T or F?

True

Medicare Part D services are provided only through private companies. T or F?

True

Northern California is one of the most highly concentrated hospital markets in the entire United States. T or F?

True

One potential reason health care spending in the US is higher than in other similar nations is because the intensity (i.e. the number of services provided) of hospital visits are very high. T or F?

True

One potential reason that health care spending in the US is higher than in similar nations is because the price of services is much higher in the US. T or F?

True

Premium tax credits can be used to buy a Bronze, Silver, Gold, or Platinum plan. T or F?

True

States can include non-required and non-optional populations within its Medicaid program, but the state is responsible for the full cost of such populations. T or F?

True

The ACA prohibits insurance companies from placing yearly or lifetime limits on the amount of care an individual can get in a year. T or F?

True

We often see variation in health care prices within the same health care system. T or F?

True