Questions and Answers
The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs?
What is the maximum Social Security Disability benefit amount an insured can receive?
Medicare is a hospital and medical expense insurance program.
True
Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?
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Medicare Part A and Part B do NOT pay for?
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The individual who provides general medical care for a patient as well as the referral for specialized care is known as a?
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The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)?
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Medicare is intended for all of the following groups EXCEPT?
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Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?
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Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?
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Study Notes
Social Security Disability Income
- Benefits are determined by an individual's Primary Insurance Amount (PIA).
- Provides financial assistance to those unable to work due to disability.
Social Security Disability Benefits
- Maximum benefit amount is 100% of the insured's PIA.
- Benefits may be reduced by retirement plan income.
Medicare Overview
- Functions primarily as a hospital and medical expense insurance program.
- Not a disability program, although it aids eligible individuals.
Provider Networks
- Preferred Provider Organization (PPO) contracts with a network of doctors and hospitals.
- Offers prearranged costs for services, providing flexibility in healthcare choice.
Medicare Coverage Limitations
- Medicare Part A and Part B do not cover dental work.
- Covers hospitalization, skilled nursing care, and physical therapy.
Primary Care Physician
- The main healthcare provider responsible for general medical care.
- Refers patients to specialized care as needed.
Managed Care Systems
- A closed panel setup means physicians are salaried employees within an HMO facility.
- Limits patient choice in the network.
Medicare Eligibility
- Excludes individuals enrolled as full-time students.
- Includes individuals 65 and older, those with chronic kidney failure, and those on Social Security disability for 24 months.
Insurance Payment Systems
- Commercial insurers reimburse the insured directly for covered medical expenses.
- Different from managed care organizations that have specific payment arrangements with providers.
PPO vs HMO Comparison
- PPOs are less restrictive than HMOs because they allow a broader choice of physicians.
- PPOs typically do not require referrals to see specialists.
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Description
Test your knowledge on Health concepts with these flashcards focused on Social Security Disability Income and related benefits. Each card presents a question that challenges your understanding of important financial aspects in healthcare. Perfect for anyone studying health insurance policies.
