Pubh 6012 Exam 2 TEST | QUESTIONS AND
CORRECT ANSWERS | GRADED A+ | VERIFIED
ANSWERS | JUST RELEASED (LATEST TEST)
prescription drug doughnut hole - ANSWER✔✔-gap in prescription drug coverage
between a limit for coverage and catastrophic coverage
T/F Medicare Advantage offers less choice in provider than traditional medicare -
ANSWER✔✔-true because medicare advantage is similar to managed care-- there is a
preferred or required network of providers where you can receive care, traditional
medicare is fee-for-service from any medicare provider
prospective payment - ANSWER✔✔-A method of reimbursement based on payment
rates that are established in advance and reflect an average of what a service should
cost. used by medicare
who might be more likely to stay on traditional medicare - ANSWER✔✔-someone who
wants to keep their dr, someone who has more expensive care
before ACA who qualified for medicaid - ANSWER✔✔-low-income AND another
eligibility category (disabled, pregnant, a child)
, how is medicaid financed - ANSWER✔✔-jointly financed by state and fed, fed chips in
50-76% depending on the state, money is attached with conditions for different
populations covered and services provided
11 15 waiver - ANSWER✔✔-allows states to add populations covered by their medicaid
program, need to apply and have it be approved, would lead to more federal funding
for adding that population
t/f the majority of children is covered under medicaid/ CHIP - ANSWER✔✔-true
medicaid churn - ANSWER✔✔-people getting kicked off of medicaid when they get a
new job that pays them "too much" to be on medicaid, but then they go back on it after
that job is over (i.e. in seasonal or temporary work)
what are the 3 pathways that make someone eligible for medicare - ANSWER✔✔-over
65, qualify for social security disability income, diagnosis of a rapid terminal disease
(i.e. late stage renal failure or ALS)
medicare part a - ANSWER✔✔-hospital insurance / inpatient care
Medicare Part B - ANSWER✔✔-The part of the Medicare program that pays for
physician services, outpatient hospital services, durable medical equipment, and other
services and supplies.
Medicare Part C (Medicare Advantage) - ANSWER✔✔-•Replaces and covers expenses
found in Part A and B
CORRECT ANSWERS | GRADED A+ | VERIFIED
ANSWERS | JUST RELEASED (LATEST TEST)
prescription drug doughnut hole - ANSWER✔✔-gap in prescription drug coverage
between a limit for coverage and catastrophic coverage
T/F Medicare Advantage offers less choice in provider than traditional medicare -
ANSWER✔✔-true because medicare advantage is similar to managed care-- there is a
preferred or required network of providers where you can receive care, traditional
medicare is fee-for-service from any medicare provider
prospective payment - ANSWER✔✔-A method of reimbursement based on payment
rates that are established in advance and reflect an average of what a service should
cost. used by medicare
who might be more likely to stay on traditional medicare - ANSWER✔✔-someone who
wants to keep their dr, someone who has more expensive care
before ACA who qualified for medicaid - ANSWER✔✔-low-income AND another
eligibility category (disabled, pregnant, a child)
, how is medicaid financed - ANSWER✔✔-jointly financed by state and fed, fed chips in
50-76% depending on the state, money is attached with conditions for different
populations covered and services provided
11 15 waiver - ANSWER✔✔-allows states to add populations covered by their medicaid
program, need to apply and have it be approved, would lead to more federal funding
for adding that population
t/f the majority of children is covered under medicaid/ CHIP - ANSWER✔✔-true
medicaid churn - ANSWER✔✔-people getting kicked off of medicaid when they get a
new job that pays them "too much" to be on medicaid, but then they go back on it after
that job is over (i.e. in seasonal or temporary work)
what are the 3 pathways that make someone eligible for medicare - ANSWER✔✔-over
65, qualify for social security disability income, diagnosis of a rapid terminal disease
(i.e. late stage renal failure or ALS)
medicare part a - ANSWER✔✔-hospital insurance / inpatient care
Medicare Part B - ANSWER✔✔-The part of the Medicare program that pays for
physician services, outpatient hospital services, durable medical equipment, and other
services and supplies.
Medicare Part C (Medicare Advantage) - ANSWER✔✔-•Replaces and covers expenses
found in Part A and B
