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HPAM 3600E Final Exam

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HPAM 3600E Final Exam

Institution
Hpam 3600
Course
Hpam 3600

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Medicare supplement insurance, private insurance type for people enrolled in the
original (not Medicare Advantage) Medicare Program. Covers out-of-pocket costs
that are not covered by Medicare, but does not cover extended long-term care,
vision, dental, hearing aids, or private nursing


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Medigap

,Co-payment or co-insurance, an amount the beneficiary pays per service after the
deductible is met


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Cost-Sharing




Name and describe the 3 common kinds of managed care structures


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1) Health Maintenance Organization (HMO)
-Pays providers a salary or capitation
-Beneficiaries may only use in-network providers
-Coordinates and controls receipt of services
2) Preferred Provider Organization (PPO)
-Pays provider on a discounted fee schedule
-Beneficiary may use in- or out-of-network providers
3) Point of Service Plans (POS)
-Combines features of HMO and PPO
-Pays providers with capitation or other risk-sharing arrangement
-Has a provider network; beneficiaries may use out-of-network provider for
designated services
-Has a gatekeeper to control and coordinate care




In 2016, _____% of the US population was uninsured.


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, 8.8




How is Medicare financed?


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1.45% of earnings paid by each employee and their employer, or 2.9% for
the self-employed




System used to classify various diagnoses for inpatient hospital stays into groups and
subgroups


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Diagnosis-Related Group Reimbursement (DRG)




A 10-year, $40 billion block grant program designed to provide health insurance to
low-income children whose family income is above the Medicaid eligibility level in
their state


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Children's Health Insurance Program (CHIP)




Name and describe the 4 parts of Medicare.

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Institution
Hpam 3600
Course
Hpam 3600

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