Questions and Answers
What does the term 'deductible' refer to in health insurance?
Which of the following best describes 'premium' in the context of health insurance?
What is the main role of Medigap coverage in the Medicare program?
Which part of Medicare typically covers hospital services?
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How are coinsurance charges usually calculated?
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Which of the following best describes Medicaid eligibility criteria?
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What is a 'copayment' in health insurance terminology?
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What is an insurer's 'network' in terms of health care?
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What costs can Medigap policies help cover?
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What is required for beneficiaries to enroll in a Medigap policy?
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What distinguishes Medicare from Medicaid?
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Which of the following services are typically not covered by Medigap policies?
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Which statement about Medicaid is true?
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What is a common requirement for Medicaid eligibility?
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Which of the following is NOT covered by Medicaid?
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What is the primary role of the insurer in an insurance agreement?
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What does the insured pay to the insurance company to transfer risk?
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What is an example of an employer-based program for insurance?
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What concept helps insurance companies determine the premiums to charge?
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Which type of insurance typically has little to no out-of-pocket expenses?
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What is true about most policyholders with insurance?
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Under which conditions might an individual pay higher rates for care?
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Which of the following programs is government-based insurance?
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What is a key factor in the insurance company's financial strategy?
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What typically happens to emergency care and hospital services regarding insurance?
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What was the purpose of the Social Security Act of 1935?
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Which president was in office when Medicare was established in 1965?
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What is a requirement for every Medicare Part D plan regarding formularies?
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What does Medicare Part A primarily cover?
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Which of the following statements about the Medicare Part D drug benefit is true?
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Which companies are among the five dominant providers of Medicare Part D plans?
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Which agency is the largest under the Department of Health & Human Services?
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Who is eligible for Medicare?
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What is the primary purpose of Medication Therapy Management under Medicare?
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What is true about premium costs for Medicare Part A?
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What represents the average out-of-pocket expenses for Medicare beneficiaries per year?
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What was the main purpose of the Affordable Care Act in relation to Medicare?
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Which of the following best describes Medigap coverage?
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Who pays for Medicare Part B premiums?
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Which group of beneficiaries is targeted for Medication Therapy Management?
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How does Medicare Part D impact the pricing of medications?
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How many Americans are covered by Medicare?
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Which option best describes the two main ways to receive Medicare coverage?
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In what year was Medicare Part D created?
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What percentage of health expenditures does Medicare cover for its beneficiaries?
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Study Notes
Basic Insurance Principles
- Understand key insurance terms: deductible, copayment, coinsurance, premium, and network.
- Medicare has four parts:
- Part A: Hospital insurance
- Part B: Medical insurance
- Part C: Medicare Advantage plans
- Part D: Prescription drug coverage.
- Coverage, cost, and eligibility differ among Medicare Parts A, B, C, and D.
- Medigap provides supplemental coverage to help cover costs not paid by Medicare.
Medicaid Overview
- Medicaid eligibility is income-based and includes categories like children, pregnant women, elderly, and disabled individuals.
- The program is administered by states with federal funding support, covering low-income Americans.
- In 2020, over 75 million enrolled in Medicaid and CHIP, costing $359.6 billion in total spending.
Important Insurance Terminology
- Beneficiary: Individual eligible for insurance benefits.
- Deductible: Amount paid by the insured before insurance coverage kicks in.
- Copayment: Fixed fee paid for specific medical services.
- Coinsurance: Percentage of costs shared between the insured and insurance.
- Premium: Monthly cost of the insurance policy.
- Network: Group of contracted healthcare providers with the insurer.
Medicare History and Structure
- Medicare originated from the Social Security Act of 1935 and was established in 1965 under President Lyndon B. Johnson.
- It serves individuals aged 65 and older, certain younger people with disabilities, and those with end-stage renal disease.
- By 2020, Medicare spent $776 billion, representing 12% of federal spending.
Medicare Coverage Options
- Original Medicare: Includes Part A and Part B, providing hospital and medical insurance.
- Medicare Advantage: Alternative option combining Part A and Part B with additional benefits.
Medicare Part D Details
- Introduced by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, offering a voluntary prescription drug benefit.
- Enrolled individuals choose from at least 20 prescription drug plans (PDPs) that cover various medications.
- Mandatory drug management protocols to ensure appropriate medication use and reduce adverse events.
Medigap Coverage Insights
- Medigap supplements original Medicare but does not include drug coverage.
- Individuals must already have Medicare Parts A and B to obtain Medigap.
- Covers additional costs like copayments and deductibles not covered by Medicare, but not services like long-term care or dental care.
Medicaid Funding and Administration
- Medicaid funded mainly through federal and state contributions, with federal government covering at least half of expenses.
- Each state administers its own Medicaid program, adhering to federal guidelines while defining eligibility.
Medicaid Coverage Requirements
- States must cover essential services like hospital care, physician services, and laboratory tests.
- Optional services vary by state and may include prescription drugs, dental care, and hearing aids.
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Description
This quiz focuses on fundamental concepts of insurance, particularly Medicare components including Parts A, B, C, and D. Students will learn essential terms like deductible, copayment, and coinsurance and distinguish between coverage, costs, and eligibility. Medigap coverage and its relevance will also be discussed.
