Part B expenses are paid primarily from the ____ (SMI) trust fund

Supplementary medical insurance

How was Medicare Part D funded

Supplementary medical insurance trust fund

establishes broad guidlines that the states use to design and run their individual programs

Centers for medicare and medicaid services

Targeted beneficiaries for MTM services must have:

Multiple Medications, multiple chronic conditions, High drug costs

Part A: What is included the in the coverage?

Skilled nursing facility care and home health care, Inpatient hospital care, hospice care

What is generally not covered in Medicare part B?

dental care, eyeglasses, hearing aids

Resource- based relative value scale is the cost fo providing each service divided into three components:

professional liability insurance, practice expense, Physician work

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SAdmin lectures 1-5

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Answers

1
Part B expenses are paid primarily from the ____ (SMI) trust fund
secondary medical insurance
Supplementary medical insurance
Social security medical insurance
stewart medical insurance
2
better assured of receiving most of the payment for services rendered
Insurers
subscribers
providers
3
Health insurance program for eligible individuals and families with low incomes and resources
Medigap
Medicare
medikade
medicaid
4
Medicare Part D program is a...
automatic enorollement program
voluntary enrollment program
5
How was Medicare Part D funded
Hospital insurance trust fund
Supplementary medical insurance trust fund
SNF insurance trustfund
6
establishes broad guidlines that the states use to design and run their individual programs
Centers for medical services
Centers for medicare services
Centers for medicaid services
Centers for medicare and medicaid services
7
Funded through payroll taxes (majority) and patient coast sharing (deductibles)
Part C
part B
Part A
Part C
8
can decrease the administrive costs associated with providing the health insurance
insurers
subscribers
providers
9
Not legal: some companies will refuse to pay for condition that were diagnosed before enrollment
pre-existing period
elimination condition
elimination period
pre-existing conditon
10
risk in which loss is the only possible outcome
speculative risk
partial risk
pure risk
primary risk
11
45% of medicare beneficiaries enrolled in Part C in 2020
True
False
12
Private prescription drug programs cover...
only Rx drugs
health care services including Rx drugs
13
business policies of denying coverage to people that are expected to be more $$$ based on job, past use, and past meds
redlining
cherry picking
redflagging
profitable picking
14
insurance was designed to help people reduce speculative risk not pure risk
True
False
15
single largest health insurance program in the US
Medicare
medicaid
16
Medicare revenues are highest in part...
Part D
Part C
Part A
Part B
17
Medicare only pays for about 1/4 of elderly peoples health care bills
True
False
18
what consumers know compared to what insurers know gives consumers an advantage when looking for covereage to meets need
information symmetry
information asymmetry
information blocking
information selection
19
Health "insurance" is more appropriately described as...
health assurance
health issuance
health ensurance
health guidance
20
business policies of picking out profitable customers from a large base
redflagging
redlining
cherry picking
profitable picking
21
Determined by state, similar to MCN, receive same benfit as mandated, if states provide service, fed. matching funds
Mandates categorically needy
medically needy
Optionaly categorically needy
22
Reimbursement in traditioinal health insurance received by...
just the provider
patient and provider
just the patient
employer and patient
23
middle men of the insurance industry, third parties that manage prescription programs
provider benefit managers
Third party administrators
pharmacy managers
pharmacy benefit managers
24
A phenomenon that says for every $1 you spend towards medicaid or state health insurance, the better the economy
multiplier affect
multiplier effect
Multiple affect
Multiple sclerosis
25
Stew goes to the hospital for 12 days. goes home for 2 mths, and returns. What day of hospital stay is he on? medicare
13th
72nd
12th
1st, it starts over
26
Saving money on medicaid often saves money for the states economy due to the multiplier effect
True
False
27
Targeted beneficiaries for MTM services must have:
Multiple Medications
multiple chronic conditions
Low family income
High drug costs
28
Part A: What is included the in the coverage?
Skilled nursing facility care and home health care
Inpatient hospital care
out patient care
hospice care
29
premiums based on demographic info, past medical use, family history, etc.
cost rating
individual rating
community rating
experience rating
30
doctors and health care providers agree to accept the medicare-approved amount as the total payment for services
medicaid assignment
medicare assignment
cost- sharing assginment
coinsurance assignment
31
FDR dropped efforts to inlcude a health insurance program in the original 1935 social security act
fair deal
great society
1965 amendments to SSA
new deal
32
Most Medicare advantage plans do NOT include Medicare prescription drug coverage (MA-PDs)
True
False
33
Who is the largest funding for mental health care?
Federal government
Medicare
Medigap
medicaid
34
PDP and MA-PDs MUST have an MTM program that MAY be provided by a pharmacist
False
True
35
set limits on the amounts that insurers can vary premiums based on health status
premium bands
average premium
rate bands
index rate
36
What is generally not covered in Medicare part B?
dental care
durable medical equipment
eyeglasses
hearing aids
37
medigap policy that requires a beneficiary to use specific hospitals and in some cases specific doctors to get full cov.
medicare premeir
Managed care
Medicare select
Medicare advantage
38
TPAs underwrite insurance risk
False
True
39
a fixed amount you pay for al health service usually when you receive the service, can very by type of service
Coinsurance
premium
Copayment
deductible
40
Resource- based relative value scale is the cost fo providing each service divided into three components:
professional liability insurance
physician liability insurance
practice expense
Physician work
41
insurance companies can refuse to pay for service unless beneficiary is enrolled for certain period of time
pre-existing condition
elimination periods
elimination conditions
pre-existing periods
42
Medicaid participates in balanced billing
True
False
43
a large employer that self funds employee health benefits acts as...
sponor
insurer
44
refer to coverage provided directly by the organization seeking coverage for its members, directly takes on risk
fully insured
partially insured
self insured
individually insured
45
Life time reserve days start over after each benefit period?
True
False
46
the price paid in advance for purchasing an insurance policy
deductible
premium
copayment
Coinsurance
47
the amount you pay for health care services before your health insurance begins to pay
copayment
Coinsurance
premium
Deductible
48
MA plans must cover all of the services that original medicare covers except...
dental care
skilled nursing facilities
hospice care
vision care
49
Ram stays in a SNF for 20 days. How much is he required to pay if he has medicare?
1/2 of deductible
1/8th of deductible
only deductible and no copay
100% of costs
50
insurance protects from ___, __ by establishing contractual relations between the insured and the inssurance provider
infrequent, large loss
frequent, small loss
infrequent, small loss
frequent, large loss
51
Self- insured groups can limit exposure to risk, insurer purchasing insurance against excessive claims
Reinsurance
co-insurer
post insurance
back up insurance
52
What is the difference between Part A eligibility and Part B?
Part A 95% voluntarily enroll
Part B automatically enrolls consumers
Both automatically enroll consumers
Part B 95% voluntarily enroll
53
Medicare pays __ of approved charge for a given service; the patient pays __ and may pay more if assign. not accepted
40% 60%
60% 40%
80% 20%
20% 80%
54
after medical expense, income falls below state establish MNIL, states not required to offer medicaid to these people
Medically needy
Mandated categorically needy
optionally categorically needy
55
covers only the employee
self insurance
self only plan
individual insurance
self assured plan
56
You must be enrolled in ______ in order to use a health saving account, lower premium with higher deductible
TPA
high down payment health plan
HSA
high deductible health plan
57
the Federal gov. requires the states to have a medicaid program
False
True
58
the % of medicaid program costs paid by the federal gov
Federal Medicaid Assistance Percentage
Funding Medicaid Assistance Program
Federal Medical Assistance Percentage
Funding Medical Assistance Percentage
59
payment received after services are provided
prospective
retrospective
60
risk resulting in uncertain degree of gain or loss
primary risk
spectacular risk
speculative risk
pure risk
61
trading the uncertainty of loss for the certainy of loss in the form of premiums, deductibles, copays, and coninsurance
employee health insurance
private health insurance
health insurance
public health insurance
62
federal health insurance for people age 65 or older, some disbaled under age 65, and people with renal disease or Lou G
medicaid
medicare
63
healthcare provided by private insurance companies approved by medicare to adminiter Part A and Part B coverage
Medicare Premeir
medicare Select
Medicare Part C
Medicare Advantage
64
Medicare advantage plans are NOT supplemental coverage
True
False
65
Which state has the highest FMAP?
Missouri
Alabama
Mississippi
California
66
PDPs and MA-PDs should establish a medication therapy management (MTM) program
False
True
67
When does a benefit period start and end for medicare patients?
When it is determined that beneficiary will stay more than 3 days
when a beneficiary hasnt received any hospital care for 90 consecutive days
when a beneficiary hasnt received any hospital care for 60 consecutive days
the day a beneficiary goes to a hospital or skilled nursing facility
68
excess HI trust fund rev. amounts are loaned to federal gov. and used to pay for toher federal obligations when...
Income<expenditures
income=expenditures
income> expenditures
69
_____ are paid primarily from the hospital insurance trust fund
Part A
Part C
Part B
Part D
70
Who does medicaid state programs make reimbursements to
providers
providers, they dont accept it in full
providers and beneficiares
beneficiaries
71
your share of the costs of a health care service. usually figured as a % of the amount we allow to be charged for servic
copayment
premium
coinsurance
deductibe
72
By law, the FMAP cannot be lower than ___ or higher than ____
lower than 50%
lower than 47%
higher than 85%
higher than 83%
73
Who is the main payer of nursing home care?
medicaid
Medigap
Medicare
beneficiaries
74
Pays for patient share of health care charges (like copays, coinsurance, deductibles)
medicare select
Medifill
medigap
medicare advantage
75
Which is the correct equation for FMAP
1 - 45 x [(state PCI)2/ (US PCI)2]
1- 45 x [(state PCI)3/ (US PCI) 3]
1- 0.45 x [(state PCI)3/(US PCI)3]
1- 0.45 x [(state PCI)2/ (US PCI)2]
76
the duration of time during which insurance pays for covered services
Benefit period
Cost- sharing
Annualized benefit
consumer period
77
How many medicare beneficiaries purchased Medigap in 2018?
1/2
1/4
1/7
1/3
78
Medicare is technically the largest insurance program in the country because Medicaid i consists of 56 diff. programs
False
True
79
deductibles, copayments, and coinsurance are all used to _____ patient out of pocket costs and ______ health care use
reduce, reduce
reduce, increase
increase, reduce
increase, increase
80
Cost of claims, adminstrative expenses, and risk charge(profit) reflects...
copayments
premiums
deductibles
primary payments
81
If stew is on his 73 day in the hospital for his benefit period, how much of the total cost is he resposible for,medicar
only the deductible
1/4 of the deductible
100% of costs
1/2 of the deductible
82
Do not need to pay as much up front money for health care services
providers
subscribers
insurers
83
Part A: What qualifies 16% of the population for medicare who may be under age 65?
they have end stage renal disease
they have lou Gehrigs
receiving disability benefit from social security for at least 24 months
they have cancer
84
Who purchases private health insurance
the government
individuals
Employer
union
85
You must have Part A and Part B to be able to purchase Medigap
False
True
86
3 broad groups that may be coverd by medicaid
situationally categorically needy
Optionally categorically needy
mandated categorically needy
medically needy
87
Most people do NOT pay a monthly Part A premium
True
False
88
If you are entitled to Part A and enrolled in part B, you are able to get Rx drug coverage through...
Part D
Part C
89
Stew stayed in the hospital for 10 days. He went home for a month, and returned. What day is he on for his hospital stay
40th
1st, it starts over
11th
10th
90
payment is based on number of patients managed, irrespective of their condition or type/intesity of service provided
prospective reimbursement
indemnity program
resource based relative value scale
capitation
91
Medicare is NOT an annualized benefit
True
False
92
a meanas tested program that is jointly funded by the state and federal gov., and is managed by the states
Medicaid
Medicare
93
kids up to 19 w/ <138% FPL, Preg. woman <133% FPL, Parents below welfare eligibility level, elder or disabled receiveSSI
mandated categorically low
medically needy
optionally categorically low
94
Ram stayed in a SNF for 75 days. How much is he required to pay if he has medicare?
only the deductible
100% of costs
1/8 of deductible
1/4 of deductibel
95
Part A: 84% of people qualify for automatic enrollment of Medicare because...
they are at least 65 years old and eligible regarless of income
they are eligible because their total income is <= 20,000 a year
they are citizens or permanent residents of the US
they or their spouse work for at 10 years in medicare covered employment
96
plan that the sponsor purchases health coverage from a state-licensed insurer/ carrier who assumes risk of the enorolled
fully insured
self- funded
self insured
partially insured
97
Part B premiums are the same for each enrolled member with monthly payments of $148.50/month
True
False
98
health insurance coverage through a plan purchased by an individual from a private company
private insurance
public insurance
direct- purchae plan
indirect- purchase plan
99
Beneficiaries enrolled in MA plan usually pay one monthly premium for the additional services
False
True
100
the possibility that redistribution of risk changes people's behaviors, typically overconsumption of resources
mortal combat
moral hazard
mortal hazard
mortality

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