HCA 202 COMPREHENSIVE EXAM 2025/2026 QUESTIONS
AND SOLUTIONS GRADED A+ TIP
✔✔individual health insurance - ✔✔individually purchased (nongroup) private health
insurance.
example of users: family farmer, early retiree, the employee of a business that does not
offer health insurance, self-employed
✔✔managed care plans - ✔✔offered mainly be health maintenance organizations
(HMOs) and preferred provider organizations (PPOs). Such plans assume risk in
exchange for an insurance premium. THey assume the responsibility for obtaining
health care services for their enrollees by contracting with a network of providers.
✔✔high deductible health plans - ✔✔insurance plan with a low premium cost; two types
of arrangements exist that both link a savings account to high-deductible insurance
which give consumers greater control over how to use the funds. They minimize moral
hazard and make consumers responsible users of health care resources.
two types:
Health Reimbursement Arrangement and Health Savings account
✔✔health reimbursement arrangement - ✔✔funded by the employer; employees are
prohibited from contributing to it. The funds are used to reimburse the insured for
qualified medical expenses, which include payment of HDHP premiums. Employees do
not pay taxes on the payments made to them. Although participants in an HRA aren't
required to have an HDHP, the arrangement commonly includes both. When coupled
with an HDHP, the employee first pays for health care from the HRA and then pays for
care on a out of pocket basis until the health plan deductible is met and HDHP kicks in.
✔✔health savings account - ✔✔a tax-advantaged medical savings account available to
taxpayers in the United States who are enrolled in a high-deductible health plan;
combines with an HDHP that meets federal standards that require caps on yearly
amounts contributed to it.
The funds belong to the account holder and can accumulate without limit.
Advantages: contributions are tax deductible, withdrawals used to pay for medical
expenses are exempt from federal income taxes, and account earnings are tax exempt
✔✔private insurance mandates under the ACA - ✔✔10) legal residents of the US were
mandated to have minimum essential coverage. Failing to comply results in an income
tax penalty ($325 per person or 2% of household income, whichever is higher).
Exemptions granted based on established religious opposition to insurance and having
to spend more than 8% of household income on it.
, 2) to purchase health insurance through government-run exchanges, subsidies are
made available to people with incomes between 100% to 400% of the FPL
3) the exchanges offer 4 types of standardized plans (bronze-platinum) that is tiered
according to premium cost and cost sharing. Bronze is the least expensive and covers
60% of health care costs.
4) Employers with 100 or more full time workers
must cover at least 70% of their full time workers in 2015 and 95% by 2016. Employers
between 50-99 must comply by 2016 and employers with less than 50 employees are
exempt.
5) the ACA makes it illegal to deny health insurance to people with preexisting medical
conditions and had required children and young adults under 26 to be covered under
their parent's plans
✔✔categorical programs - ✔✔supported by public financing; each are designed to
provide benefits to a certain category of people who meet the eligibility criteria to
become beneficiaries
✔✔medicare - ✔✔also referred to as title 18 of the social security act, it finances
medical care for three categories of people:
-persons 65 or older
-disabled individuals of any age who are entitled to SS benefits
-people of any age with end stage renal disease
-it is a federal program administered by the CMS and has a four part structure
✔✔medigap - ✔✔extra health insurance that you buy from a private company to pay
health care costs not covered by Original Medicare, such as co-payments, deductibles,
and health care if you travel outside the U.S.
✔✔medicare part a - ✔✔hospital insurance portion of medicare; it is financed by a
special payroll tax paid equally by employers and employees.
it is designed to cover hospitalization, short-term convalescence and rehab in a SNF,
and home health care. For terminally ill, it covers hospice.
✔✔benefit period - ✔✔the way the Original Medicare program measures your use of
inpatient hospital and skilled nursing facility (SNF) services. It begins the day that you
enter a hospital or SNF and ends when you have not received inpatient hospital or
Medicare-covered skilled care in a SNF for 60 days in a row
-has a 90 days of maximum coverage; beyond that, there is a lifetime reserve of 60
additional hospital inpatient days to which a higher copay applies
AND SOLUTIONS GRADED A+ TIP
✔✔individual health insurance - ✔✔individually purchased (nongroup) private health
insurance.
example of users: family farmer, early retiree, the employee of a business that does not
offer health insurance, self-employed
✔✔managed care plans - ✔✔offered mainly be health maintenance organizations
(HMOs) and preferred provider organizations (PPOs). Such plans assume risk in
exchange for an insurance premium. THey assume the responsibility for obtaining
health care services for their enrollees by contracting with a network of providers.
✔✔high deductible health plans - ✔✔insurance plan with a low premium cost; two types
of arrangements exist that both link a savings account to high-deductible insurance
which give consumers greater control over how to use the funds. They minimize moral
hazard and make consumers responsible users of health care resources.
two types:
Health Reimbursement Arrangement and Health Savings account
✔✔health reimbursement arrangement - ✔✔funded by the employer; employees are
prohibited from contributing to it. The funds are used to reimburse the insured for
qualified medical expenses, which include payment of HDHP premiums. Employees do
not pay taxes on the payments made to them. Although participants in an HRA aren't
required to have an HDHP, the arrangement commonly includes both. When coupled
with an HDHP, the employee first pays for health care from the HRA and then pays for
care on a out of pocket basis until the health plan deductible is met and HDHP kicks in.
✔✔health savings account - ✔✔a tax-advantaged medical savings account available to
taxpayers in the United States who are enrolled in a high-deductible health plan;
combines with an HDHP that meets federal standards that require caps on yearly
amounts contributed to it.
The funds belong to the account holder and can accumulate without limit.
Advantages: contributions are tax deductible, withdrawals used to pay for medical
expenses are exempt from federal income taxes, and account earnings are tax exempt
✔✔private insurance mandates under the ACA - ✔✔10) legal residents of the US were
mandated to have minimum essential coverage. Failing to comply results in an income
tax penalty ($325 per person or 2% of household income, whichever is higher).
Exemptions granted based on established religious opposition to insurance and having
to spend more than 8% of household income on it.
, 2) to purchase health insurance through government-run exchanges, subsidies are
made available to people with incomes between 100% to 400% of the FPL
3) the exchanges offer 4 types of standardized plans (bronze-platinum) that is tiered
according to premium cost and cost sharing. Bronze is the least expensive and covers
60% of health care costs.
4) Employers with 100 or more full time workers
must cover at least 70% of their full time workers in 2015 and 95% by 2016. Employers
between 50-99 must comply by 2016 and employers with less than 50 employees are
exempt.
5) the ACA makes it illegal to deny health insurance to people with preexisting medical
conditions and had required children and young adults under 26 to be covered under
their parent's plans
✔✔categorical programs - ✔✔supported by public financing; each are designed to
provide benefits to a certain category of people who meet the eligibility criteria to
become beneficiaries
✔✔medicare - ✔✔also referred to as title 18 of the social security act, it finances
medical care for three categories of people:
-persons 65 or older
-disabled individuals of any age who are entitled to SS benefits
-people of any age with end stage renal disease
-it is a federal program administered by the CMS and has a four part structure
✔✔medigap - ✔✔extra health insurance that you buy from a private company to pay
health care costs not covered by Original Medicare, such as co-payments, deductibles,
and health care if you travel outside the U.S.
✔✔medicare part a - ✔✔hospital insurance portion of medicare; it is financed by a
special payroll tax paid equally by employers and employees.
it is designed to cover hospitalization, short-term convalescence and rehab in a SNF,
and home health care. For terminally ill, it covers hospice.
✔✔benefit period - ✔✔the way the Original Medicare program measures your use of
inpatient hospital and skilled nursing facility (SNF) services. It begins the day that you
enter a hospital or SNF and ends when you have not received inpatient hospital or
Medicare-covered skilled care in a SNF for 60 days in a row
-has a 90 days of maximum coverage; beyond that, there is a lifetime reserve of 60
additional hospital inpatient days to which a higher copay applies
