Podcast
Questions and Answers
What is a health care system?
What is a health care system?
A group of people, agencies, and/or institutions that provide health care services to individuals in a variety of settings.
Who are health care professionals?
Who are health care professionals?
Properly trained and licensed or certified providers of health care.
What is the purpose of the health care system?
What is the purpose of the health care system?
To improve the health for populations seeking care.
What is a copayment?
What is a copayment?
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What is a deductible?
What is a deductible?
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What is coinsurance?
What is coinsurance?
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What are diagnosis-related groups (DRGs)?
What are diagnosis-related groups (DRGs)?
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What is the principal diagnosis?
What is the principal diagnosis?
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What are secondary diagnoses?
What are secondary diagnoses?
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What part of the Medicare plan will you need to fill a prescription?
What part of the Medicare plan will you need to fill a prescription?
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Which of the following can be covered by Medicare Part B?
Which of the following can be covered by Medicare Part B?
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Medicare Part C, also known as the Medicare Advantage Plan, is run by the government.
Medicare Part C, also known as the Medicare Advantage Plan, is run by the government.
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What is Medicaid?
What is Medicaid?
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How do individuals qualify for Medicaid?
How do individuals qualify for Medicaid?
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What does CHIP stand for?
What does CHIP stand for?
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At what level is Medicaid managed?
At what level is Medicaid managed?
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What is TRICARE?
What is TRICARE?
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Who manages and regulates TRICARE?
Who manages and regulates TRICARE?
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Does TRICARE cover the families of those who have served, or who are currently serving, in the military?
Does TRICARE cover the families of those who have served, or who are currently serving, in the military?
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Is TRICARE health insurance for anyone who's a U.S. citizen?
Is TRICARE health insurance for anyone who's a U.S. citizen?
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Define a preferred provider organization (PPO).
Define a preferred provider organization (PPO).
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Define health maintenance organization (HMO).
Define health maintenance organization (HMO).
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What are the two types of private health insurance?
What are the two types of private health insurance?
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What are government health care plans?
What are government health care plans?
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How many different parts does Medicare have?
How many different parts does Medicare have?
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What is a diagnosis-related group?
What is a diagnosis-related group?
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Which program is funded by both federal and state governments and serves low-income families?
Which program is funded by both federal and state governments and serves low-income families?
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What is The Affordable Care Act (ACA)?
What is The Affordable Care Act (ACA)?
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What does the Preexisting Condition Insurance Plan (PCIP) allow?
What does the Preexisting Condition Insurance Plan (PCIP) allow?
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Study Notes
Health Care System Overview
- A health care system consists of people, agencies, and institutions that deliver health care services in various settings.
- Health care professionals are licensed or certified providers trained to deliver health care effectively.
Purpose and Financial Terms
- The main purpose of the health care system is to enhance the health of populations who seek care.
- Copayment refers to a fixed amount dictated by an insurance plan that individuals must pay for each health service.
- A deductible is the total amount a person must pay out of pocket before their insurance pays for any expenses.
- Coinsurance involves sharing the costs of health services between an individual and their insurance provider.
Diagnosis and Medicare
- Diagnosis-related groups (DRGs) classify inpatient stays into groups for payment purposes.
- Principal diagnosis indicates the main condition requiring a patient's hospital admission, while secondary diagnoses are complications that may affect treatment or length of stay.
- Medicare Part D is necessary for filling prescriptions, while Medicare Part B covers durable medical equipment (DME).
Medicaid and Children's Health
- Medicaid is the largest federal and state-funded health insurance source for low-income families in the U.S.
- To qualify for Medicaid, individuals or families must earn below the poverty level, as defined by the Department of Health and Human Services.
- CHIP stands for Children's Health Insurance Program, focusing on providing health insurance for children.
Military Health Care
- TRICARE offers health insurance for military service members and their families, managed by the Department of Defense.
- TRICARE is exclusive to U.S. military personnel and does not cover all U.S. citizens.
Private Health Insurance
- A preferred provider organization (PPO) allows for reduced health care costs through agreements between various healthcare entities.
- A health maintenance organization (HMO) arranges managed care for its members and acts as a liaison with providers, operating on a prepaid basis.
- Two primary forms of private health insurance are HMOs and PPOs.
Government Health Care Plans
- Government health care plans include Medicare, Medicaid, TRICARE, and CHIP.
- Medicare consists of four distinct parts that provide various services and coverage options.
Legislation and Health Coverage
- The Affordable Care Act (ACA) broadened Medicaid coverage and improved services for low-income Americans.
- The Preexisting Condition Insurance Plan (PCIP) allows individuals with preexisting health conditions to obtain health insurance coverage.
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Description
This quiz explores key concepts in the health care system, including the roles of professionals, financial terms like copayment and deductible, and diagnosis classification under Medicare. Test your knowledge about how health care services are delivered and funded.