HLSA300 MIDTERM EXAM QUESTIONS WITH SOLUTIONS
GUARANTEE A+ 2025
✔✔access, preventable mortality, life expectancy, infant mortality, chronic illness -
✔✔even though us has higher healthcare spending, we do worse on what outcomes?
✔✔experience rating - ✔✔how did insurance companies used to set rates?
✔✔community rating - ✔✔how do insurance companies set rates now?
✔✔age smoking location - ✔✔what factors can insurance companies use to set your
rates with the aca?
✔✔adverse selection - ✔✔A high-risk person benefits more from insurance, so is more
likely to purchase it.
✔✔no out of network, need referrals, copayments, preauthorizations - ✔✔what are the
qualities of an hmo?
✔✔no referrals or preauthorizations, can go out of network, coinsurance - ✔✔what are
the qualities of a ppo?
✔✔no referrals or preauthorizations but cannot go out of network - ✔✔what are the
qualities of an epo?
✔✔need referrals and preauthorizations in network, copayments in network,
coinsurance out of network - ✔✔what are the qualities of a pos?
✔✔over 65, receiving ssi for disability 2 years or more, end stage renal disease -
✔✔who qualifies for medicare?
✔✔price - ✔✔the amount that is actually paid to providers after negotiation
✔✔charge - ✔✔the retail price for health services
✔✔cost - ✔✔how much it actually costs to deliver a health service
✔✔capitation - ✔✔paying one set rate for all services rendered during a given time
period
✔✔drg - ✔✔paying one fee for multiple services for a specific diagnosis (used by
medicare to pay hospitals)
, ✔✔when quality is greater than cost - ✔✔when do we get value out of healthcare?
✔✔medicare acos - ✔✔what is an example of an attempt at population health?
✔✔yes - ✔✔do some medicare beneficiaries also use private insurance?
✔✔50 million - ✔✔how many were uninsured in 2009?
✔✔EMTALA - ✔✔law that states that anyone in an emergency or active labor must be
treated regardless of ability to pay, but they can be billed later
✔✔childless adults - ✔✔who was medicaid expanded to?
✔✔decrease - ✔✔after the aca, did employer sponsored insurance increase or
decrease?
✔✔eligibility, income of population, employer size and industry, ineligible populations -
✔✔what drives variation in insurance among states?
✔✔cost sharing prohibitive, networks may be limited, may lack certain benefits,
geography, convenience, cultural beliefs, compliance - ✔✔why is access not always
guaranteed even with insurance?
✔✔no - ✔✔can the federal gov negotiate with drug companies?
✔✔20% - ✔✔how much profit can insurance companies make for overhead costs?
✔✔health policy decisions, growth of technology, other costs - ✔✔what affects
healthcare costs?
✔✔risk - ✔✔what is the main reason we have health insurance?
✔✔both the employer and the employee - ✔✔who are insurance and other benefits tax
deductible for?
✔✔pays at least 60% cost necessary care, no lifetime or annual caps on coverage,
must limit out of pocket expenses - ✔✔what are the requirements of employer
sponsored insurance?
✔✔80% - ✔✔how much of an employee's premium does an employer usually pay?
✔✔job lock - ✔✔staying at a dead end job bc it has good health coverage that you
would otherwise be able to obtain
GUARANTEE A+ 2025
✔✔access, preventable mortality, life expectancy, infant mortality, chronic illness -
✔✔even though us has higher healthcare spending, we do worse on what outcomes?
✔✔experience rating - ✔✔how did insurance companies used to set rates?
✔✔community rating - ✔✔how do insurance companies set rates now?
✔✔age smoking location - ✔✔what factors can insurance companies use to set your
rates with the aca?
✔✔adverse selection - ✔✔A high-risk person benefits more from insurance, so is more
likely to purchase it.
✔✔no out of network, need referrals, copayments, preauthorizations - ✔✔what are the
qualities of an hmo?
✔✔no referrals or preauthorizations, can go out of network, coinsurance - ✔✔what are
the qualities of a ppo?
✔✔no referrals or preauthorizations but cannot go out of network - ✔✔what are the
qualities of an epo?
✔✔need referrals and preauthorizations in network, copayments in network,
coinsurance out of network - ✔✔what are the qualities of a pos?
✔✔over 65, receiving ssi for disability 2 years or more, end stage renal disease -
✔✔who qualifies for medicare?
✔✔price - ✔✔the amount that is actually paid to providers after negotiation
✔✔charge - ✔✔the retail price for health services
✔✔cost - ✔✔how much it actually costs to deliver a health service
✔✔capitation - ✔✔paying one set rate for all services rendered during a given time
period
✔✔drg - ✔✔paying one fee for multiple services for a specific diagnosis (used by
medicare to pay hospitals)
, ✔✔when quality is greater than cost - ✔✔when do we get value out of healthcare?
✔✔medicare acos - ✔✔what is an example of an attempt at population health?
✔✔yes - ✔✔do some medicare beneficiaries also use private insurance?
✔✔50 million - ✔✔how many were uninsured in 2009?
✔✔EMTALA - ✔✔law that states that anyone in an emergency or active labor must be
treated regardless of ability to pay, but they can be billed later
✔✔childless adults - ✔✔who was medicaid expanded to?
✔✔decrease - ✔✔after the aca, did employer sponsored insurance increase or
decrease?
✔✔eligibility, income of population, employer size and industry, ineligible populations -
✔✔what drives variation in insurance among states?
✔✔cost sharing prohibitive, networks may be limited, may lack certain benefits,
geography, convenience, cultural beliefs, compliance - ✔✔why is access not always
guaranteed even with insurance?
✔✔no - ✔✔can the federal gov negotiate with drug companies?
✔✔20% - ✔✔how much profit can insurance companies make for overhead costs?
✔✔health policy decisions, growth of technology, other costs - ✔✔what affects
healthcare costs?
✔✔risk - ✔✔what is the main reason we have health insurance?
✔✔both the employer and the employee - ✔✔who are insurance and other benefits tax
deductible for?
✔✔pays at least 60% cost necessary care, no lifetime or annual caps on coverage,
must limit out of pocket expenses - ✔✔what are the requirements of employer
sponsored insurance?
✔✔80% - ✔✔how much of an employee's premium does an employer usually pay?
✔✔job lock - ✔✔staying at a dead end job bc it has good health coverage that you
would otherwise be able to obtain
