RM Final Exam questions and answers
graded A+
Deductible (health insurance) - correct answer ✔✔the amount that must be paid yearly by the patient
before the insurance agency will begin making payments
-Annual, not per occurrence
-individual vs family
Coinsurance
-applies after deductible is met
-typically 80/20
-Out of pocket maximum
-the maximum amount the insured will pay for covered expenses before the health policy pays 100%
Co-pay
-set dollar amount that insured pays to access services
Example 1: out of pocket maximum - correct answer ✔✔-Family of four, $3,000 individual deductible,
$5,000 family deductible, 80/20 co-insurance
-Daughter has spent $3,000 toward her deductible, father has $4,000 in covered expenses.
-Insured would pay all of the first $2,000 to satisfy the family deductible, then 20% of the remaining
$2,000, which is $400
Example 2: out of pocket maximum - correct answer ✔✔-Same family and policy.
-Daughter has spent $2,000 toward her deductible, father has covered expenses of $40,000
-Insured would pay all of the first $2,000 to satisfy the family deductible. Insured would pay 20% of
covered expenses until the family total out of pocket hits the out of pocket maximum of $10,000. This
,would happen when his bills total $30,000. The remaining $10,000 of covered expenses would be paid
by insurance.
Risk management application: health insurance - correct answer ✔✔-Avoidance is unrealistic
-Reduction and prevention are possible
-Retention is typically forced on people to some extent through deductibles and co-insurance.
-Since major health risks are low frequency/high severity, they are excellent candidates for insurance
Medicare - correct answer ✔✔-Available for anyone 65 or older, regardless of Social Security Retirement
Age
-Four parts to Medicare
-Part A - provided to Medicare recipients.
--Covers inpatient hospital stays, skilled nursing care, hospice care, limited home health services.
--Subject to deductibles and co-insurance
--Not all services are covered.
-Part B - option but highly recommended
--In 2020, cost is $144.60 per month.
--Covers "Medically Necessary Services" and "Preventive Services"
--Part A is hospital. Part B is doctor
--Small annual deductible of $198 in 2020 plus 80/20 co-insurance
Part D- prescription drug coverage
-Provided by independent insurance companies.
-Each company sets premiums, typically $15 - $25 a month.
-Higher premiums = lower co-pays.
-Standard deductible of $435 in 2020.
Part C: Medicare Advantage plus
, -Covers many of the same items as Parts A and B but covers deductibles and co-insurance.
-Likely adds coverage like dental, vision, hearing aids, and fitness classes
-Offered by individual insurance companies who set their own premiums and coverages.
A person can only enroll in Medicare - correct answer ✔✔-For three months prior to age 65
-For one month after age 65
-Annually during open enrollment which is January 1 through March 31.
Medicaid - correct answer ✔✔-Medicaid is health insurance for indigents who can't afford traditional
health insurance.
-Medicaid covers all health costs including nursing home stays.
-Does not cover prescriptions
-Only available to those with assets of less than $2,000 and income less than $2,349 per month
-Income must be spent before Medicaid begins paying.
health care costs have ______ from 1960 to 2018 - correct answer ✔✔risen
reasons for healthcare costs increases - correct answer ✔✔-Costs of prescription drug development
-Increasing technology and concurrent costs
-Administration costs
-Chronic care cost
Obamacare - correct answer ✔✔-Enacted in 2010
-Phased in the first few years
-Three basics of ACA/Obamacare:
-Everyone had to have approved health insurance
-All approved policies had to contain 10 essential health benefits
-Anyone without approved insurance had to pay a penalty up to 2% of AGI
graded A+
Deductible (health insurance) - correct answer ✔✔the amount that must be paid yearly by the patient
before the insurance agency will begin making payments
-Annual, not per occurrence
-individual vs family
Coinsurance
-applies after deductible is met
-typically 80/20
-Out of pocket maximum
-the maximum amount the insured will pay for covered expenses before the health policy pays 100%
Co-pay
-set dollar amount that insured pays to access services
Example 1: out of pocket maximum - correct answer ✔✔-Family of four, $3,000 individual deductible,
$5,000 family deductible, 80/20 co-insurance
-Daughter has spent $3,000 toward her deductible, father has $4,000 in covered expenses.
-Insured would pay all of the first $2,000 to satisfy the family deductible, then 20% of the remaining
$2,000, which is $400
Example 2: out of pocket maximum - correct answer ✔✔-Same family and policy.
-Daughter has spent $2,000 toward her deductible, father has covered expenses of $40,000
-Insured would pay all of the first $2,000 to satisfy the family deductible. Insured would pay 20% of
covered expenses until the family total out of pocket hits the out of pocket maximum of $10,000. This
,would happen when his bills total $30,000. The remaining $10,000 of covered expenses would be paid
by insurance.
Risk management application: health insurance - correct answer ✔✔-Avoidance is unrealistic
-Reduction and prevention are possible
-Retention is typically forced on people to some extent through deductibles and co-insurance.
-Since major health risks are low frequency/high severity, they are excellent candidates for insurance
Medicare - correct answer ✔✔-Available for anyone 65 or older, regardless of Social Security Retirement
Age
-Four parts to Medicare
-Part A - provided to Medicare recipients.
--Covers inpatient hospital stays, skilled nursing care, hospice care, limited home health services.
--Subject to deductibles and co-insurance
--Not all services are covered.
-Part B - option but highly recommended
--In 2020, cost is $144.60 per month.
--Covers "Medically Necessary Services" and "Preventive Services"
--Part A is hospital. Part B is doctor
--Small annual deductible of $198 in 2020 plus 80/20 co-insurance
Part D- prescription drug coverage
-Provided by independent insurance companies.
-Each company sets premiums, typically $15 - $25 a month.
-Higher premiums = lower co-pays.
-Standard deductible of $435 in 2020.
Part C: Medicare Advantage plus
, -Covers many of the same items as Parts A and B but covers deductibles and co-insurance.
-Likely adds coverage like dental, vision, hearing aids, and fitness classes
-Offered by individual insurance companies who set their own premiums and coverages.
A person can only enroll in Medicare - correct answer ✔✔-For three months prior to age 65
-For one month after age 65
-Annually during open enrollment which is January 1 through March 31.
Medicaid - correct answer ✔✔-Medicaid is health insurance for indigents who can't afford traditional
health insurance.
-Medicaid covers all health costs including nursing home stays.
-Does not cover prescriptions
-Only available to those with assets of less than $2,000 and income less than $2,349 per month
-Income must be spent before Medicaid begins paying.
health care costs have ______ from 1960 to 2018 - correct answer ✔✔risen
reasons for healthcare costs increases - correct answer ✔✔-Costs of prescription drug development
-Increasing technology and concurrent costs
-Administration costs
-Chronic care cost
Obamacare - correct answer ✔✔-Enacted in 2010
-Phased in the first few years
-Three basics of ACA/Obamacare:
-Everyone had to have approved health insurance
-All approved policies had to contain 10 essential health benefits
-Anyone without approved insurance had to pay a penalty up to 2% of AGI
