Healthcare Finance Exam 2 Study Guide
Why do we have health insurance? - correct answer ✔✔To set aside money for a large unexpected
expenditure, pool money to spread out risk
Who are the parties involved in health insurance? - correct answer ✔✔i. Patient
ii. Providers
iii. Payers- insurance
information asymmetry - correct answer ✔✔Provider know more about what service you need than you
do
moral hazard - correct answer ✔✔Ability to decide if you need something is skewed because you don't
have to pay full price for it
adverse selection - correct answer ✔✔The unhealthy people are more likely to sign up for health
insurance than healthy because it is of more value to them
benficiary - correct answer ✔✔1. Person who is benefiting from insurance policy, policy holder
deductible - correct answer ✔✔1. The amount you pay for covered health care service before your
insurance starts to pay
co-payment - correct answer ✔✔1. Amount you pay for specific services when you go to get it.
premium - correct answer ✔✔1. Monthly fee you pay for health insurance coverage
what do premiums have to cover? - correct answer ✔✔a. Profit and the cost of service, running business
of insurance company
, co-insurance - correct answer ✔✔1. Your portion of medical cost you pay after deductible has been met
Out of pocket maximum - correct answer ✔✔1. The max amount you can pay out of pocket for benefit
period
What is the most common type of health insurance? - correct answer ✔✔Employer-based, indemnity
What are the public insurance programs? - correct answer ✔✔i. Medicare, Medicaid, CHIP, Tricare,
veterans affairs
What is meant by performance-based pay? - correct answer ✔✔Reimbursement to provider that is
based on the quality of care they are providing, based on quality, patient safety, and patient satisfaction
When were Medicare and Medicaid signed into law? - correct answer ✔✔1965
Who funds Medicare? - correct answer ✔✔federal government
Who has authority over the administration of the Medicare program? - correct answer ✔✔federal level
Who does Medicare cover? - correct answer ✔✔- 65 years and older
- Permanent disability
- End stage renal disease
- ALS
What does Part A of Medicare cover? - correct answer ✔✔1. Hospital insurance
a. Inpatient care
b. Rehabilitations
c. Hospice
d. Home health care
e. Skilled nursing facilities
Why do we have health insurance? - correct answer ✔✔To set aside money for a large unexpected
expenditure, pool money to spread out risk
Who are the parties involved in health insurance? - correct answer ✔✔i. Patient
ii. Providers
iii. Payers- insurance
information asymmetry - correct answer ✔✔Provider know more about what service you need than you
do
moral hazard - correct answer ✔✔Ability to decide if you need something is skewed because you don't
have to pay full price for it
adverse selection - correct answer ✔✔The unhealthy people are more likely to sign up for health
insurance than healthy because it is of more value to them
benficiary - correct answer ✔✔1. Person who is benefiting from insurance policy, policy holder
deductible - correct answer ✔✔1. The amount you pay for covered health care service before your
insurance starts to pay
co-payment - correct answer ✔✔1. Amount you pay for specific services when you go to get it.
premium - correct answer ✔✔1. Monthly fee you pay for health insurance coverage
what do premiums have to cover? - correct answer ✔✔a. Profit and the cost of service, running business
of insurance company
, co-insurance - correct answer ✔✔1. Your portion of medical cost you pay after deductible has been met
Out of pocket maximum - correct answer ✔✔1. The max amount you can pay out of pocket for benefit
period
What is the most common type of health insurance? - correct answer ✔✔Employer-based, indemnity
What are the public insurance programs? - correct answer ✔✔i. Medicare, Medicaid, CHIP, Tricare,
veterans affairs
What is meant by performance-based pay? - correct answer ✔✔Reimbursement to provider that is
based on the quality of care they are providing, based on quality, patient safety, and patient satisfaction
When were Medicare and Medicaid signed into law? - correct answer ✔✔1965
Who funds Medicare? - correct answer ✔✔federal government
Who has authority over the administration of the Medicare program? - correct answer ✔✔federal level
Who does Medicare cover? - correct answer ✔✔- 65 years and older
- Permanent disability
- End stage renal disease
- ALS
What does Part A of Medicare cover? - correct answer ✔✔1. Hospital insurance
a. Inpatient care
b. Rehabilitations
c. Hospice
d. Home health care
e. Skilled nursing facilities
