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CEBS GBA EXAM BANK 2025| BRAND NEW ACTUAL EXAM BANK WITH 100% VERIFIED QUESTIONS AND CORRECT SOLUTIONS| GUARANTEED VALUE PACK| ACE YOUR GRADES. What is the basic assumption underlying concept of a free market and how is it challenged by the theory of "bounded rationality?" (Mod 1.1) - - CORRECT ANSAssumption that rational customers will make informed decisions about value, quality and price, while producers who meet consumer's demands will be rewarded with market share and profit. However, this is challenged by the consumer's "bounded rationality" - rational consumer is only functional up to a certain point because choices are constrained or bound by limited knowledge and understanding of their choices. What are economic benefits of a free market? (Mod 1.1) - - CORRECT ANSIf an individual does not like their provider or health plan, the should be able to "vote with their feet" and select other options. This choice empowers customers, regulates producers and drives efficiency. Describe several ways the US Healthcare market does not function like a normal market. (Mod 1.1) - - CORRECT ANSHealthcare market has significant asymmetry in information between consumers, providers and insurers. Moral hazard is a problem because the marginal cost of covered care is zero, causing some to overconsume medical care. Many consumers choose doctors initially by convenience, accessibility or recommendation. Cost has also been shown to be lower on priority scale for choosing a provider. List several recent initiatives in the US that purport (to claim, often falsely) to use market forces to increase efficiency in the healthcare system. (Mod 1.1) - CORRECT ANS1) Employers are offering more HDHPs with some as high as $10,000. These plans, often paired with HSAs, are coupled with the idea of transparency, or making more info available to consumer on cost and quality. Idea is that consumers will have more skin in game and be prudent purchasers of care with their own money. 2) ACA is creating marketplaces that employ a form of managed competition where standardized health plans compete on cost and quality. 3) Public Medicaid and Medicare programs are moving towards requiring or making choices available for managed care products that structure care within provider networks. Indicate the approximate percentages of the population covered by major health programs. (Mod 1.2) - - CORRECT ANSLargest portion of Americans (48%) receive health insurance through an Employer, 16% through Medicaid, 15% through Medicare, 6% purchase insurance on their own How did ACA change Medicare? (Mod 1.2) - - CORRECT ANSACA expanded Medicare's wellness and prevention benefits, improved prescription drug coverage and financed experiments to control health care costs by testing alternative payment methods and delivery systems. How did ACA change eligibility for Medicaid benefits and how is this change affecting the number of people who are enrolled? (Mod 1.2) - - CORRECT ANSACA shifted program eligibility from category based (ex: single parents with dependents or people w/disabilities) to an income- based standard. Medicaid once covered fewer than half of low-income Americans, but now ACA Medcaid expansion has been steadily increasing enrollment, with largest increase in the states who are participating. Explain significance of US Supreme Court case National Federation of Independent Business v Sebelius in 2012 (Mod 1.2) - - CORRECT ANSACA sought to expand Medicaid coverage to all individuals and families with incomes below 138% of the poverty level. US (first time) would have had a solid safety net of insurance coverage for all lower income citizens. In the case, the court rules states could choose not to expand (and Medicaid funding would not be withheld). By Jan 2015, 25 states chose not to expand. How has ACA affected number of uninsured Americans? (Mod 1.2) - - CORRECT ANSPrior to ACA, 16.3% or 49.9 million Americans were uninsured. By 2014, this number reduced to 13% and by the first quarter of 2016 to 8.6%. Describe private health insurance coverage with regard to a) size of firm b) HDHPs with Medical Savings Accounts c) variability of coverage by states (Mod 1.2) - - CORRECT ANSa) 98% of employers with 200+ EE's offer health insurance but fewer than 45% of firms with 3-9 EE's do so. Larger employers offer more choice of health plans than smaller employers; small employers tend to offer POS plans that require higher EE cost sharing to go outside network. b) In 2006, HDHPs with medical savings accounts accounted for 4% of ER- sponsored market, but by 2012, accounted for over 20%. In 2016, this rose to almost 30%. c) Range of ER-based options and quality of options available vary widely by state. The percentage of the population covered by private insurance varies as well as the options for different types of coverage. What are the basic differences between the four medal categories of ACA health plans? (Mod 1.3) - - CORRECT ANSBronze, Silver, Gold and Platinum plans all have same actuarial value. However, they differ in regard to amount of deductibles, coinsurance, other out of pocket costs and premiums. Bronze plan has lowest premium but most out of pocket costs. Platinum plan has lowest out of pocket cost, but highest premium. Why is the Silver Plan the most popular choice among ACA plans? (Mod 1.3) - - CORRECT ANSMajority who enroll are eligible for federal tax credit subsidies tied to a Silver level plan. People may still select a higher cost Gold or Platinum plan, but will have to pay higher premiums. Cost-sharing subsidies to lower out of pocket costs are only available to Silver plans. Do users of ACA marketplace exchanges have many choices and does evidence indicate they choose the most cost-effective plans? (Mod 1.3) - - CORRECT ANSTon of choices and options (ex: in TX, 15 carriers offered an average of 31 plans per county). A consumer comparing plans may see different premiums, coinsurance and deductibles, but plans also may differ on every measure of out of pocket costs including physician copays, ER payments, hospital stay payments. Studies have found despite wide range of benefits, people are not choosing most cost-effective plans people on average choose plan 10% more expensive than what would be optimal. Other studies suggest limiting variation in plan designs would be choices more comprehensible (able to understand). What is the provision in Part D Medicare law that gives a significant benefit to pharmaceutical companies? (Mod 1.4) - - CORRECT ANSPart D Medicare Law prohibits the government from using its purchasing power to negotiate widespread discounts with drug plans. Do Medicare Part D beneficiaries have many choices and does the evidence suggest they choose the most cost-effective plans? (Mod 1.4) - - CORRECT ANSProvide numerous choices (ex MA has 27 standalone, TX has 32). Most people do not select the optimal plan or take advantage of open enrollment periods to obtain a more cost-effective plan. Few people switch plans even when it would be in their advantage to do so. Define each part of Medicare (A,B,C,D) and the services provided under each (Mod 1.4 - Reading) - - CORRECT ANSPart A = Hospital Services Part B = Physician & Diagnostic Services Part C = Medicare Advantage - Alternative Managed Care Option Part D = Prescription Drugs 26.-Greatest choices in Part D and the Medicare Advantage Plan, which is where most of analysis is focused on. 27.-C and D are paid out of pocket by recipients; A & B are funded by payroll deductions (taxes) 28.What is Medicare Part C and why do some people select it? (Mod 1.4) - - CORRECT ANSAKA Medicare Advantage: 29.-Recipients have the option to enroll in a health plan with a narrowed network of hospitals and providers that covers Part A and B but with lower out of pocket costs. These plans often include their own prescription drug coverage. Unlike Part D, this is a voluntary choice and beneficiaries always have the option of going back to the traditional plan. It is a choice to restrict options and consolidate the different elements of Medicare, including cost sharing. People select these plans because of lower costs and greater care coordination. Like Part D, Part C has significant state variation. What have researchers found with regard to consumer benefits and efficiency of Medicare Part C? (Mod 1.4) - - CORRECT ANS45 studies - in general that Part C's HMO and PPO programs have a better record than traditional fee for service plans in the provision of preventive services and the more efficient use of resources. Despite high performance, a sub-group of sick beneficiaries in traditional Medicare tends to rate their care more favorably than beneficiaries in Part C - due to easier access to specialists. Compared to Part D (which provides a separate, uncoordinated prescription drug benefit), choice here is less complex and could lead to greater consumer benefits and efficiency.