Nurs 4800 - Final Exam questions n
answers graded A+
the amount you pay out of pocket before your insurance kicks in - correct answer
✔✔Deductible
a set fee you pay upfront before a covered medical service or procedure - correct answer
✔✔Copay
the percentage you pay for a service or procedure once you've met the deductible - correct
answer ✔✔coinsurance
The most you will payfor covered services in a rolling year. Once met, your insurance company
will pay 100% of covered expenses for the rest of the year. - correct answer ✔✔out of pocket
maximum
federally assisted and state-administered program to pay for medical services on behalf of
certain groups of low-income individuals. Generally, these individuals are not covered by Social
Security. Certain groups of people (older adults, blind, disabled, members of families with
dependent children, and certain other children and pregnant women) also qualify for coverage
if their incomes and resources are sufficiently low - correct answer ✔✔medicaid
nationwide health insurance program authorized under Title18 of the SSA that provides benefits
to people aged 65 years or older.Medicare coverage also is available to certain groups of people
withcatastrophic or chronic illness, such as older patients with renal failure,requiring
hemodialysis, regardless of age. - correct answer ✔✔medicare
Part of Original Medicare, this helps cover inpatient hospital stays, care in a skillednursing
facility, hospice care and some home healthcare - correct answer ✔✔medicare A
, Part of Original Medicare, helps cover certain doctors' and preventive services, outpatient care
and medical supplies. - correct answer ✔✔medicare B
These plans are offered by private insurers approved by Medicare. By law, Medicare Advantage
plans must offer, at minimum, the same benefits as Original Medicare Part A and Part B. Most
Medicare Advantage plans also include coverage for prescriptiondrugs, and many include some
coverage for dental, vision and hearing care, as well - correct answer ✔✔medicare C
this medicare is insurance for prescription drugs sold through private insurance companies -
correct answer ✔✔medicare D
- patient classification system that standardizes prospective payment to hospitals and
encourages cost containment initiatives
- Starting in the 1980's - Medicare pays a single amount for your hospitalization according to
your DRG which is based on your age, gender, diagnosis, and the surgical procedure involved. -
correct answer ✔✔diagnostic related group
- describe a variety of health-care plans designed to contain the cost of health care services
delivered to members while maintaining the quality of care.
- pays set price for a specific procedure or service.•
- one of the most common types of this is an HMO which is a network of providers funded by
insurance premiums.
•The point of service HMO, the patient can select a provider outside of the network, but will
pay a higher premium and copayment to do so. - correct answer ✔✔managed care
people covered by this:
• children through age 18 in families with income below 138% of the federal poverty line
($29,974 for a family of three);
• people who are pregnant and have income below 138% of the poverty line;
answers graded A+
the amount you pay out of pocket before your insurance kicks in - correct answer
✔✔Deductible
a set fee you pay upfront before a covered medical service or procedure - correct answer
✔✔Copay
the percentage you pay for a service or procedure once you've met the deductible - correct
answer ✔✔coinsurance
The most you will payfor covered services in a rolling year. Once met, your insurance company
will pay 100% of covered expenses for the rest of the year. - correct answer ✔✔out of pocket
maximum
federally assisted and state-administered program to pay for medical services on behalf of
certain groups of low-income individuals. Generally, these individuals are not covered by Social
Security. Certain groups of people (older adults, blind, disabled, members of families with
dependent children, and certain other children and pregnant women) also qualify for coverage
if their incomes and resources are sufficiently low - correct answer ✔✔medicaid
nationwide health insurance program authorized under Title18 of the SSA that provides benefits
to people aged 65 years or older.Medicare coverage also is available to certain groups of people
withcatastrophic or chronic illness, such as older patients with renal failure,requiring
hemodialysis, regardless of age. - correct answer ✔✔medicare
Part of Original Medicare, this helps cover inpatient hospital stays, care in a skillednursing
facility, hospice care and some home healthcare - correct answer ✔✔medicare A
, Part of Original Medicare, helps cover certain doctors' and preventive services, outpatient care
and medical supplies. - correct answer ✔✔medicare B
These plans are offered by private insurers approved by Medicare. By law, Medicare Advantage
plans must offer, at minimum, the same benefits as Original Medicare Part A and Part B. Most
Medicare Advantage plans also include coverage for prescriptiondrugs, and many include some
coverage for dental, vision and hearing care, as well - correct answer ✔✔medicare C
this medicare is insurance for prescription drugs sold through private insurance companies -
correct answer ✔✔medicare D
- patient classification system that standardizes prospective payment to hospitals and
encourages cost containment initiatives
- Starting in the 1980's - Medicare pays a single amount for your hospitalization according to
your DRG which is based on your age, gender, diagnosis, and the surgical procedure involved. -
correct answer ✔✔diagnostic related group
- describe a variety of health-care plans designed to contain the cost of health care services
delivered to members while maintaining the quality of care.
- pays set price for a specific procedure or service.•
- one of the most common types of this is an HMO which is a network of providers funded by
insurance premiums.
•The point of service HMO, the patient can select a provider outside of the network, but will
pay a higher premium and copayment to do so. - correct answer ✔✔managed care
people covered by this:
• children through age 18 in families with income below 138% of the federal poverty line
($29,974 for a family of three);
• people who are pregnant and have income below 138% of the poverty line;
