Health Insurance Providers Chapter 2
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Questions and Answers

The health insurance program which is administered by each state and funded by both the federal and state governments is called?

Medicaid

Medicaid was designed to assist individuals who are?

below a specific income limit

Medicare is intended for all of the following groups, EXCEPT?

Those enrolled as a full-time student

Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?

<p>More physicians to choose from</p> Signup and view all the answers

J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price. What type of plan does J belong to?

<p>Health Maintenance Organization</p> Signup and view all the answers

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a?

<p>Primary Care Physician</p> Signup and view all the answers

Which type of provider is known for stressing preventative medical care?

<p>Health Maintenance Organizations (HMO's)</p> Signup and view all the answers

Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)?

<p>PPO's are NOT a type of managed care systems</p> Signup and view all the answers

Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?

<p>Commercial insurer</p> Signup and view all the answers

Medicare Part A and Part B do NOT pay for?

<p>dental work</p> Signup and view all the answers

Study Notes

Health Insurance Programs

  • Medicaid: A health insurance program administered by states, funded by federal and state governments, designed for low-income individuals.
  • Medicaid Eligibility: Specifically assists individuals below a certain income threshold.

Medicare Overview

  • Medicare: Federal program providing health coverage primarily for seniors and specific groups.
  • Exclusion: Not intended for individuals enrolled as full-time students.

Types of Health Insurance Plans

  • Preferred Provider Organization (PPO): Offers flexibility with a broader range of physician options compared to Health Maintenance Organizations (HMOs).
  • Health Maintenance Organization (HMO): Requires members to select a primary care physician (PCP) and emphasizes preventive medical care.

Primary Care

  • Primary Care Physician: Generalist who provides medical care and referrals to specialists.

Managed Care Systems

  • PPOs and Managed Care: Incorrectly categorized as not being managed care systems; PPOs are indeed a type of managed care offering greater flexibility than HMOs.

Insurance Payment Types

  • Commercial Insurer: Directly reimburses insured individuals for covered medical expenses, differing from plans that pay providers directly.

Medicare Coverage Limitations

  • Exclusions of Coverage: Medicare Parts A and B do not cover dental work, highlighting the importance of understanding specific plan benefits.

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Description

Test your knowledge on health insurance providers with this quiz focused on Chapter 2. Explore key concepts such as Medicaid, Medicare, and the populations they serve. Perfect for students studying health insurance and policy.

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