Podcast
Questions and Answers
The health insurance program which is administered by each state and funded by both the federal and state governments is called?
The health insurance program which is administered by each state and funded by both the federal and state governments is called?
Medicaid
Which of the following does Social Security NOT provide benefits for?
Which of the following does Social Security NOT provide benefits for?
What is Medicare?
What is Medicare?
It is a hospital and medical expense insurance program.
The individual who provides general medical care for a patient as well as the referral for specialized care is known as a?
The individual who provides general medical care for a patient as well as the referral for specialized care is known as a?
Signup and view all the answers
Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?
Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)?
Signup and view all the answers
Which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements?
Which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements?
Signup and view all the answers
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?
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?
Signup and view all the answers
A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?
A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?
Signup and view all the answers
Which of these is considered a true statement regarding Medicaid?
Which of these is considered a true statement regarding Medicaid?
Signup and view all the answers
Which of the following organizations reimburses its insureds for covered medical expenses?
Which of the following organizations reimburses its insureds for covered medical expenses?
Signup and view all the answers
What do Medicare parts A and B cover?
What do Medicare parts A and B cover?
Signup and view all the answers
Medicare part A and part B do not pay for?
Medicare part A and part B do not pay for?
Signup and view all the answers
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)?
The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n)?
Signup and view all the answers
Medicare is intended for all of the following groups EXCEPT?
Medicare is intended for all of the following groups EXCEPT?
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?
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?
Signup and view all the answers
The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs?
The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs?
Signup and view all the answers
A medical care provider which typically delivers health services at its own local medical facility is known as a?
A medical care provider which typically delivers health services at its own local medical facility is known as a?
Signup and view all the answers
What is the maximum Social Security Disability benefit amount an insured can receive?
What is the maximum Social Security Disability benefit amount an insured can receive?
Signup and view all the answers
Which of the following statements is true about most Blue Cross/Blue Shield organizations?
Which of the following statements is true about most Blue Cross/Blue Shield organizations?
Signup and view all the answers
Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)?
Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)?
Signup and view all the answers
Which type of provider is known for stressing preventative medical care?
Which type of provider is known for stressing preventative medical care?
Signup and view all the answers
Medicaid was designed to assist individuals who are?
Medicaid was designed to assist individuals who are?
Signup and view all the answers
Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?
Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?
Signup and view all the answers
Study Notes
Health Insurance Overview
- Medicaid is a health insurance program funded by both federal and state governments.
- Social Security does NOT provide benefits for dismemberment.
- Medicare is a program that covers hospital and medical expenses.
Primary Care and Coverage Types
- A Primary Care Physician provides general medical care and referrals for specialized care.
- Preferred Provider Organizations (PPOs) offer a wider choice of physicians and hospitals compared to Health Maintenance Organizations (HMOs).
- HMOs are prepaid group health plans where members pay in advance for services from participating physicians and hospitals.
Medical Cost Management
- PPOs involve a group of doctors and hospitals that contract with insurers for services at prearranged costs.
- A group health plan is considered primary coverage if an insured individual is injured while walking in a park.
- Medicaid is funded by both federal and state governments.
Medicare and Its Components
- Medicare Part A covers hospitalization, while Part B covers doctor's services.
- Medicare does NOT cover dental care.
- Medicare is not intended for individuals enrolled as full-time students.
Organizational Structure and Responsibilities
- A closed panel represents an HMO with salaried physician employees working at the HMO's facility.
- Health Maintenance Organizations stress preventative medical care.
Insurance Claim Practices
- Commercial insurers reimburse insured individuals for covered medical expenses.
- Medicaid assists individuals below a specific income level.
- Commercial insurers make reimbursement payments directly to insured individuals.
Social Security and Disability
- The percentage of an individual's Primary Insurance Amount (PIA) determines benefits paid under Social Security Disability Income.
- The maximum Social Security Disability benefit is 100% of the insured's PIA.
- Most Blue Cross/Blue Shield organizations operate as nonprofit entities.
Miscellaneous
- PPOs are types of managed care systems, contrary to the incorrect statement that they are NOT.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Explore key concepts related to health insurance providers through this informative flashcard quiz. Test your knowledge on programs like Medicaid and Medicare, as well as benefits offered by Social Security. Perfect for students and professionals in the healthcare field.
