HLSA300 ACTUAL EXAM QUESTIONS WITH ANSWERS 2025/2026
GRADED A+
to reduce the rate of healthcare spending to a manageable growth rate - what does it
mean to bend the cost curve?
federal gov ONLY - who funds medicare?
both state and fed gov - who funds medicaid?
higher prices for services, use more diagnostic services - why does the us have higher
healthcare spending than other countries if we do not use more health services?
increased premiums and cost sharing - how do consumers realize healthcare spending
is increasing?
private - is us insurance primarily public or private?
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?
GRADED A+
to reduce the rate of healthcare spending to a manageable growth rate - what does it
mean to bend the cost curve?
federal gov ONLY - who funds medicare?
both state and fed gov - who funds medicaid?
higher prices for services, use more diagnostic services - why does the us have higher
healthcare spending than other countries if we do not use more health services?
increased premiums and cost sharing - how do consumers realize healthcare spending
is increasing?
private - is us insurance primarily public or private?
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?
