CEBS GBA Exam 2 Questions with 100% Correct Answers Latest
Graded A+
Question:
What is the basic assumption underlying concept of a free market and how is it challenged by the
theory of "bounded rationality?" (Mod 1.1)
Answer:
Rational customers will make informed decisions about value, quality and price, while producers
who meet consumer's demands will be rewarded with market share and profit.
Question:
What are economic benefits of a free market? (Mod 1.1)
Answer:
If an individual does not like their provider or health plan, the should be able to "vote with their
feet" and select other options. This choice empowers customers, regulates producers and drives
efficiency.
Question:
Describe several ways the US Healthcare market does not function like a normal market. (Mod 1.1)
Answer:
Healthcare market has significant asymmetry in information between consumers, providers and
insurers. Moral hazard is a problem because the marginal cost of covered care is zero, causing some
to over consume medical care.
Question:
List several recent initiatives in the US that purport (to claim, often falsely) to use market forces to
increase efficiency in the healthcare system. (Mod 1.1)
Answer:
1) Employers are offering more HDHPs with some as high as $10,000.
Question:
2) ACA is creating marketplaces that employ a form of managed competition where standardized
health plans compete on cost and quality. 3) Public Medicaid and Medicare programs are moving
towards requiring or making choices available for managed care products that structure care within
,provider networks. Indicate the approximate percentages of the population covered by major health
programs. (Mod 1.2)
Answer:
Largest portion of Americans (48%) receive health insurance through an Employer, 16% through
Medicaid, 15% through Medicare, 6% purchase insurance on their own
Question:
How did ACA change Medicare? (Mod 1.2)
Answer:
ACA expanded Medicare's wellness and prevention benefits, improved prescription drug coverage
and financed experiments to control health care costs by testing alternative payment methods and
delivery systems.
Question:
How did ACA change eligibility for Medicaid benefits? (Mod 1.2)
Answer:
ACA shifted program eligibility from category based (ex: single parents with dependents or people
w/disabilities) to an income-based standard.
Question:
how has the ACA affected the number of people who are enrolled in Medicaid? (Mod 1.2)
Answer:
Medicaid once covered fewer than half of low-income Americans, but now ACA Medcaid
expansion has been steadily increasing enrollment, with largest increase in the states who are
participating.
Question:
Explain significance of US Supreme Court case National Federation of Independent Business v
Sebelius in 2012 (Mod 1.2)
Answer:
ACA sought to expand Medicaid coverage to all individuals and families with incomes below
138% of the poverty level. US (first time) would have had a solid safety net of insurance coverage
for all lower income citizens. In the case, the court rules states could choose not to expand (and
Medicaid funding would not be withheld). By Jan 2015, 25 states chose not to expand.
,Question:
How has ACA affected number of uninsured Americans? (Mod 1.2)
Answer:
Prior to ACA, 16.3% or 49.9 million Americans were uninsured. By 2014, this number reduced to
13% and by the first quarter of 2016 to 8.6%.
Question:
Describe private health insurance coverage with regard to a) size of firm b) HDHPs with Medical
Savings Accounts c) variability of coverage by states (Mod 1.2)
Answer:
a) 98% of employers with 200+ EE's offer health insurance but fewer than 45% of firms with 3-9
EE's do so. Larger
employers offer more choice of health plans than smaller employers; small employers tend to offer
POS plans that require higher EE cost sharing to go outside network.
Question:
b) In 2006, HDHPs with medical savings accounts accounted for 4% of ER- sponsored market, but
by 2012, accounted for over 20%. In 2016, this rose to almost 30%. c) Range of ER-based options
and quality of options available vary widely by state. The percentage of the population covered by
private insurance varies as well as the options for different types of coverage. What are the basic
differences between the four medal categories of ACA health plans? (Mod 1.3)
Answer:
Bronze, Silver, Gold and Platinum plans all have same actuarial value. However, they differ in
regard to amount of deductibles, coinsurance, other out of pocket costs and premiums. Bronze plan
has lowest premium but most out of pocket costs. Platinum plan has lowest out of pocket cost, but
highest premium.
Question:
Why is the Silver Plan the most popular choice among ACA plans? (Mod 1.3)
Answer:
Majority who enroll are eligible for federal tax credit subsidies tied to a Silver level plan. People
may still select a higher cost Gold or Platinum plan, but will have to pay higher premiums.
Cost-sharing subsidies to lower out of pocket costs are only available to Silver plans.
Question:
, Do users of ACA marketplace exchanges have many choices? (Mod 1.3)
Answer:
Ton of choices and options (ex: in TX, 15 carriers offered an average of 31 plans per county).
Question:
Does evidence indicate that consumers choose the most cost-effective medical plan in the
marketplace? (Mod 1.3)
Answer:
people on average choose plan 10% more expensive than what would be optimal. Other studies
suggest limiting variation in plan designs would be choices more comprehensible (able to
understand).
Question:
What is the provision in Part D Medicare law that gives a significant benefit to pharmaceutical
companies? (Mod 1.4)
Answer:
Part D Medicare Law prohibits the government from using its purchasing power to negotiate
widespread discounts with drug plans.
Question:
Do Medicare Part D beneficiaries have many choices and does the evidence suggest they choose
the most cost-effective plans? (Mod 1.4)
Answer:
Provide numerous choices (ex MA has 27 standalone, TX has 32). Most people do not select the
optimal plan or take advantage of open enrollment periods to obtain a more cost-effective plan.
Few people switch plans even when it would be in their advantage to do so.
Question:
Define each part of Medicare (A,B,C,D) and the services provided under each (Mod 1.4 - Reading)
Answer:
Part A = Hospital Services
Part B = Physician & Diagnostic Services
Part C = Medicare Advantage - Alternative Managed Care Option
Graded A+
Question:
What is the basic assumption underlying concept of a free market and how is it challenged by the
theory of "bounded rationality?" (Mod 1.1)
Answer:
Rational customers will make informed decisions about value, quality and price, while producers
who meet consumer's demands will be rewarded with market share and profit.
Question:
What are economic benefits of a free market? (Mod 1.1)
Answer:
If an individual does not like their provider or health plan, the should be able to "vote with their
feet" and select other options. This choice empowers customers, regulates producers and drives
efficiency.
Question:
Describe several ways the US Healthcare market does not function like a normal market. (Mod 1.1)
Answer:
Healthcare market has significant asymmetry in information between consumers, providers and
insurers. Moral hazard is a problem because the marginal cost of covered care is zero, causing some
to over consume medical care.
Question:
List several recent initiatives in the US that purport (to claim, often falsely) to use market forces to
increase efficiency in the healthcare system. (Mod 1.1)
Answer:
1) Employers are offering more HDHPs with some as high as $10,000.
Question:
2) ACA is creating marketplaces that employ a form of managed competition where standardized
health plans compete on cost and quality. 3) Public Medicaid and Medicare programs are moving
towards requiring or making choices available for managed care products that structure care within
,provider networks. Indicate the approximate percentages of the population covered by major health
programs. (Mod 1.2)
Answer:
Largest portion of Americans (48%) receive health insurance through an Employer, 16% through
Medicaid, 15% through Medicare, 6% purchase insurance on their own
Question:
How did ACA change Medicare? (Mod 1.2)
Answer:
ACA expanded Medicare's wellness and prevention benefits, improved prescription drug coverage
and financed experiments to control health care costs by testing alternative payment methods and
delivery systems.
Question:
How did ACA change eligibility for Medicaid benefits? (Mod 1.2)
Answer:
ACA shifted program eligibility from category based (ex: single parents with dependents or people
w/disabilities) to an income-based standard.
Question:
how has the ACA affected the number of people who are enrolled in Medicaid? (Mod 1.2)
Answer:
Medicaid once covered fewer than half of low-income Americans, but now ACA Medcaid
expansion has been steadily increasing enrollment, with largest increase in the states who are
participating.
Question:
Explain significance of US Supreme Court case National Federation of Independent Business v
Sebelius in 2012 (Mod 1.2)
Answer:
ACA sought to expand Medicaid coverage to all individuals and families with incomes below
138% of the poverty level. US (first time) would have had a solid safety net of insurance coverage
for all lower income citizens. In the case, the court rules states could choose not to expand (and
Medicaid funding would not be withheld). By Jan 2015, 25 states chose not to expand.
,Question:
How has ACA affected number of uninsured Americans? (Mod 1.2)
Answer:
Prior to ACA, 16.3% or 49.9 million Americans were uninsured. By 2014, this number reduced to
13% and by the first quarter of 2016 to 8.6%.
Question:
Describe private health insurance coverage with regard to a) size of firm b) HDHPs with Medical
Savings Accounts c) variability of coverage by states (Mod 1.2)
Answer:
a) 98% of employers with 200+ EE's offer health insurance but fewer than 45% of firms with 3-9
EE's do so. Larger
employers offer more choice of health plans than smaller employers; small employers tend to offer
POS plans that require higher EE cost sharing to go outside network.
Question:
b) In 2006, HDHPs with medical savings accounts accounted for 4% of ER- sponsored market, but
by 2012, accounted for over 20%. In 2016, this rose to almost 30%. c) Range of ER-based options
and quality of options available vary widely by state. The percentage of the population covered by
private insurance varies as well as the options for different types of coverage. What are the basic
differences between the four medal categories of ACA health plans? (Mod 1.3)
Answer:
Bronze, Silver, Gold and Platinum plans all have same actuarial value. However, they differ in
regard to amount of deductibles, coinsurance, other out of pocket costs and premiums. Bronze plan
has lowest premium but most out of pocket costs. Platinum plan has lowest out of pocket cost, but
highest premium.
Question:
Why is the Silver Plan the most popular choice among ACA plans? (Mod 1.3)
Answer:
Majority who enroll are eligible for federal tax credit subsidies tied to a Silver level plan. People
may still select a higher cost Gold or Platinum plan, but will have to pay higher premiums.
Cost-sharing subsidies to lower out of pocket costs are only available to Silver plans.
Question:
, Do users of ACA marketplace exchanges have many choices? (Mod 1.3)
Answer:
Ton of choices and options (ex: in TX, 15 carriers offered an average of 31 plans per county).
Question:
Does evidence indicate that consumers choose the most cost-effective medical plan in the
marketplace? (Mod 1.3)
Answer:
people on average choose plan 10% more expensive than what would be optimal. Other studies
suggest limiting variation in plan designs would be choices more comprehensible (able to
understand).
Question:
What is the provision in Part D Medicare law that gives a significant benefit to pharmaceutical
companies? (Mod 1.4)
Answer:
Part D Medicare Law prohibits the government from using its purchasing power to negotiate
widespread discounts with drug plans.
Question:
Do Medicare Part D beneficiaries have many choices and does the evidence suggest they choose
the most cost-effective plans? (Mod 1.4)
Answer:
Provide numerous choices (ex MA has 27 standalone, TX has 32). Most people do not select the
optimal plan or take advantage of open enrollment periods to obtain a more cost-effective plan.
Few people switch plans even when it would be in their advantage to do so.
Question:
Define each part of Medicare (A,B,C,D) and the services provided under each (Mod 1.4 - Reading)
Answer:
Part A = Hospital Services
Part B = Physician & Diagnostic Services
Part C = Medicare Advantage - Alternative Managed Care Option
