Health 2030 Exam 2 | 2026/2027 | Correct
Answers | With Complete Solutions | SURE
TO PASS!!
1. what are the 3 layers based on spending in Part D? - ANSWER
deductible, initial coverage, gap or "donut hole"
2. each state establishes its own eligibility criteria for medicaid
according to: - ANSWER income and assets--means testing
3. medicaid is a _______ financed system by _____ and ______
governments - ANSWER jointly
state and federal
4. CHIP is available to families that make too much to be eligible for
medicaid with incomes up to ______% of FPL - ANSWER 200
5. ACA mandates that individuals have ________ __________ or pay a
_____ penalty - ANSWER health insurance
Tax
6. what are the major types of managed care organizations? - ANSWER
HMOs
PPOs
Point of Service Plans
what are the 4 common HMO models? - ANSWER 1. staff model
2. group model
3. network model
4. independent practice association model
staff model employs _______ and distributes _____ as years end
based on productivity and profitability, exercises control over practice
patterns and better monitors ________ but continues to ______ due to
, high operating ______ and limited _____ of providers - ANSWER
physicians
bonuses
utilization
decline
expenses
choice
7. group model contracts with ___________ group and separately with
one or more ______. Physicians are employed by the ______, not the
____. HMO pays an all-inclusive _______ fee and/or PPS to the
practice to provide services to enrollees - ANSWER multispecialty
hospitals
practice, not the HMO
capitation
8. network model contracts with more than one _______ group practice,
is adaptable to large _________ areas, offers more ____ but a
disadvantage is the dilution of _________ control - ANSWER
medical
metropolitan
choice
utilization
9. IPA has been most _______, establishes contracts with ____ and
_____ practices, functions as an ________ representing many
physicians, disadvantage: if contract is lost, it loses large % of
_______ - ANSWER successful
solo and group practices
intermediary
, participating physicians
10. PPOs make _____ ___ arrangements with providers that range
between __% and __% off - ANSWER discounted fee arrangements
between 25% and 35%
11. POS plans combine features of ____ with patient choice found in
____. POS plans overcome ________ provider choice but retain
benefits of tight ___________. Has _______ due to high out of
pocket costs. - ANSWER HMOs and PPOs
restricted
utilization
declined
12. Integrated Health Systems - ANSWER organizational integration
and formation of alliances by providers in response to managed cares
growing power and control of patient populations
- gave rise to medical systems, partnerships between
physicians and hospitals, and IDS
-
13. a fully integrated health network includes: - ANSWER one or
more acute care hospitals
ambulatory care facilities
one or more physician group practices
one or more long term care facilities
home health services
ownership/contract with one or more HMO's
14. what are the integration types based on ownership/affiliation? -
ANSWER -acquisitions and mergers
-joint ventures
Answers | With Complete Solutions | SURE
TO PASS!!
1. what are the 3 layers based on spending in Part D? - ANSWER
deductible, initial coverage, gap or "donut hole"
2. each state establishes its own eligibility criteria for medicaid
according to: - ANSWER income and assets--means testing
3. medicaid is a _______ financed system by _____ and ______
governments - ANSWER jointly
state and federal
4. CHIP is available to families that make too much to be eligible for
medicaid with incomes up to ______% of FPL - ANSWER 200
5. ACA mandates that individuals have ________ __________ or pay a
_____ penalty - ANSWER health insurance
Tax
6. what are the major types of managed care organizations? - ANSWER
HMOs
PPOs
Point of Service Plans
what are the 4 common HMO models? - ANSWER 1. staff model
2. group model
3. network model
4. independent practice association model
staff model employs _______ and distributes _____ as years end
based on productivity and profitability, exercises control over practice
patterns and better monitors ________ but continues to ______ due to
, high operating ______ and limited _____ of providers - ANSWER
physicians
bonuses
utilization
decline
expenses
choice
7. group model contracts with ___________ group and separately with
one or more ______. Physicians are employed by the ______, not the
____. HMO pays an all-inclusive _______ fee and/or PPS to the
practice to provide services to enrollees - ANSWER multispecialty
hospitals
practice, not the HMO
capitation
8. network model contracts with more than one _______ group practice,
is adaptable to large _________ areas, offers more ____ but a
disadvantage is the dilution of _________ control - ANSWER
medical
metropolitan
choice
utilization
9. IPA has been most _______, establishes contracts with ____ and
_____ practices, functions as an ________ representing many
physicians, disadvantage: if contract is lost, it loses large % of
_______ - ANSWER successful
solo and group practices
intermediary
, participating physicians
10. PPOs make _____ ___ arrangements with providers that range
between __% and __% off - ANSWER discounted fee arrangements
between 25% and 35%
11. POS plans combine features of ____ with patient choice found in
____. POS plans overcome ________ provider choice but retain
benefits of tight ___________. Has _______ due to high out of
pocket costs. - ANSWER HMOs and PPOs
restricted
utilization
declined
12. Integrated Health Systems - ANSWER organizational integration
and formation of alliances by providers in response to managed cares
growing power and control of patient populations
- gave rise to medical systems, partnerships between
physicians and hospitals, and IDS
-
13. a fully integrated health network includes: - ANSWER one or
more acute care hospitals
ambulatory care facilities
one or more physician group practices
one or more long term care facilities
home health services
ownership/contract with one or more HMO's
14. what are the integration types based on ownership/affiliation? -
ANSWER -acquisitions and mergers
-joint ventures
