MEJO 469 Unit 2 Exam ACTUAL UPDATED QUESTIONS AND CORRECT
ANSWERS
Health Insurance A way to help you pay for medical bills (doctor visits, hospital charges, x-rays,
prescription drugs, ambulance, etc.)
How do most Americans get health insurance? About half of Americans get their insurance through their job/employer
About 20% in Medicaid, 17% in Medicare, about 5% through the military, etc.
Insurance through an employer: you pay a ________in Monthly premium, coverage
exchange for ______ That money you pay goes to the insurance company and in turn they pay for some
portion of your medical bills
In-network Which ever companies your insurance covers
Out of network Which ever companies your insurance does not cover
It's still covered, but it will cost more $$$
How is the insurance company making money? Premiums (a monthly fee)
Goal is to bring more $ in than they pay out in claims (they want healthy people
because people with medical conditions will cost them more)
, Pooling Risk Spreading out uncertainty so no one person gets stuck with a huge cost
Adjust premiums (monthly charge) based on... Age
Condition
How do insurance companies try to control costs? Requiring pre-approvals for certain procedures and drugs (doctors have to call
and explain why a patient needs it)
*AI is changing this (can write appeal letters way faster)
Rejecting claims Sometimes insurance companies will do this and then later approve it to see if you
ever give up (attempt to keep costs down)
Does the health insurer automatically pay the claim or the In-network: insurance pays the doctor directly
bill? Out-of-network: you pay first, insurance may pay you back
What happens if you don't have health insurance in the People put it off (get more sick), go to the ER ($), etc.
US? Everyone has the right to emergency care no matter if you have insurance or not
in the US, may be a big bill, but you will be treated even if you can't technically
pay for it
Subscriber/Beneficiary What you are to your employers health insurance plan
Different levels (gold, silver, bronze - more services at higher levels but higher
monthly premiums)
Co-pay How much you pay each time ($25 for a visit to the doctor)
Fixed amount, out of pocket
Different for in-network and out of network
Deductible How much you pay before insurance kicks in
Low premium and high deductible OR high premium and Depends on: how likely are you to get sick? How much can you afford to have to
low deductible? pay if you get sicker than intended?
Out-of-pocket maximum Fixed dollar upper threshold
Higher if you pay a lower premium each month
Types of insurance Private and Public
Public Programs Medicare and Medicaid
ANSWERS
Health Insurance A way to help you pay for medical bills (doctor visits, hospital charges, x-rays,
prescription drugs, ambulance, etc.)
How do most Americans get health insurance? About half of Americans get their insurance through their job/employer
About 20% in Medicaid, 17% in Medicare, about 5% through the military, etc.
Insurance through an employer: you pay a ________in Monthly premium, coverage
exchange for ______ That money you pay goes to the insurance company and in turn they pay for some
portion of your medical bills
In-network Which ever companies your insurance covers
Out of network Which ever companies your insurance does not cover
It's still covered, but it will cost more $$$
How is the insurance company making money? Premiums (a monthly fee)
Goal is to bring more $ in than they pay out in claims (they want healthy people
because people with medical conditions will cost them more)
, Pooling Risk Spreading out uncertainty so no one person gets stuck with a huge cost
Adjust premiums (monthly charge) based on... Age
Condition
How do insurance companies try to control costs? Requiring pre-approvals for certain procedures and drugs (doctors have to call
and explain why a patient needs it)
*AI is changing this (can write appeal letters way faster)
Rejecting claims Sometimes insurance companies will do this and then later approve it to see if you
ever give up (attempt to keep costs down)
Does the health insurer automatically pay the claim or the In-network: insurance pays the doctor directly
bill? Out-of-network: you pay first, insurance may pay you back
What happens if you don't have health insurance in the People put it off (get more sick), go to the ER ($), etc.
US? Everyone has the right to emergency care no matter if you have insurance or not
in the US, may be a big bill, but you will be treated even if you can't technically
pay for it
Subscriber/Beneficiary What you are to your employers health insurance plan
Different levels (gold, silver, bronze - more services at higher levels but higher
monthly premiums)
Co-pay How much you pay each time ($25 for a visit to the doctor)
Fixed amount, out of pocket
Different for in-network and out of network
Deductible How much you pay before insurance kicks in
Low premium and high deductible OR high premium and Depends on: how likely are you to get sick? How much can you afford to have to
low deductible? pay if you get sicker than intended?
Out-of-pocket maximum Fixed dollar upper threshold
Higher if you pay a lower premium each month
Types of insurance Private and Public
Public Programs Medicare and Medicaid
