HCA 2026 COMPREHENSIVE QUESTIONS AND
ANSWERS SURE A+
✔✔cost sharing - ✔✔when patients pay for a portion of health care costs not covered by
health insurance; the purpose is to reduce the misuse of insurance benefits.
-three types are utilized in private health insurance:
premium cost sharing, deductibles, and copayments
-ACA mandates that all health insurance plans must cover preventative services and
immunizations 100% and utilize this
✔✔deductible - ✔✔the amount the insured must first pay before any benefits by the
plan are payable. In most cases, it must be paid on an annual basis. The monetary
amount varies considerably by the type of plan.
✔✔copayment - ✔✔the amount that insured has to pay out of pocket each time health
services are received after the deductible amount has been paid; it is cost sharing in the
form of a dollar amount
✔✔coinsurance - ✔✔cost sharing in the form of a percent amount
ex: in a plan with 80:20, 80% of all medical expenses after the deductible requirement
has been met is covered by insurance and the additional 20% is paid by the insured.
, ✔✔stop-loss - ✔✔a provision in which the maximum out of pocket liability an insured
would incur in a given year; the purpose is to limit the total out of pocket costs for the
insured. Once the limit has been reached, the plan pays 100% of additional expenses.
✔✔private health insurance - ✔✔the modern health insurance is pluralistic and includes
many different types of this; it is generally available in the form of single or family plans.
includes 5 main types:
-group insurance
-self-insurance
-individual private insurance
-managed care plans
-high deductible health care plans
✔✔family plan - ✔✔insurance plan that covers the spouse and the children of the
subscriber in addition to the subscriber
✔✔employment based health insurance - ✔✔offer rates-- percentages of employers
who offer insurance--vary quite significantly according to employer characteristics:
-large employers vs. small employers
-greater number of high wage earners vs. low wage earners
-full time workers v part time workers
-unionized versus nonunionized employers
-smaller percentage of young workers vs. older workers
✔✔group insurance - ✔✔can be obtained through an organization such as an employer,
a union, or a professional organization. It anticipates that a substantial number of
people in the group will participate in purchasing insurance through its sponsor. Risk
and often the cost of insurance are shared by members.
✔✔self-insurance - ✔✔large employers often have a workforce that is big enough and
sufficiently well diversified in terms of risk to warrant offering its own insurance.
Rather than pay insurers a dividend to bear the risk, large employers can simply
assume the risk by budgeting funds to pay medical claims incurred by their employees.
✔✔reinsurance - ✔✔insurance purchased from a private insurance company that allows
self-insured employers to protect themselves against any potential company
✔✔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
ANSWERS SURE A+
✔✔cost sharing - ✔✔when patients pay for a portion of health care costs not covered by
health insurance; the purpose is to reduce the misuse of insurance benefits.
-three types are utilized in private health insurance:
premium cost sharing, deductibles, and copayments
-ACA mandates that all health insurance plans must cover preventative services and
immunizations 100% and utilize this
✔✔deductible - ✔✔the amount the insured must first pay before any benefits by the
plan are payable. In most cases, it must be paid on an annual basis. The monetary
amount varies considerably by the type of plan.
✔✔copayment - ✔✔the amount that insured has to pay out of pocket each time health
services are received after the deductible amount has been paid; it is cost sharing in the
form of a dollar amount
✔✔coinsurance - ✔✔cost sharing in the form of a percent amount
ex: in a plan with 80:20, 80% of all medical expenses after the deductible requirement
has been met is covered by insurance and the additional 20% is paid by the insured.
, ✔✔stop-loss - ✔✔a provision in which the maximum out of pocket liability an insured
would incur in a given year; the purpose is to limit the total out of pocket costs for the
insured. Once the limit has been reached, the plan pays 100% of additional expenses.
✔✔private health insurance - ✔✔the modern health insurance is pluralistic and includes
many different types of this; it is generally available in the form of single or family plans.
includes 5 main types:
-group insurance
-self-insurance
-individual private insurance
-managed care plans
-high deductible health care plans
✔✔family plan - ✔✔insurance plan that covers the spouse and the children of the
subscriber in addition to the subscriber
✔✔employment based health insurance - ✔✔offer rates-- percentages of employers
who offer insurance--vary quite significantly according to employer characteristics:
-large employers vs. small employers
-greater number of high wage earners vs. low wage earners
-full time workers v part time workers
-unionized versus nonunionized employers
-smaller percentage of young workers vs. older workers
✔✔group insurance - ✔✔can be obtained through an organization such as an employer,
a union, or a professional organization. It anticipates that a substantial number of
people in the group will participate in purchasing insurance through its sponsor. Risk
and often the cost of insurance are shared by members.
✔✔self-insurance - ✔✔large employers often have a workforce that is big enough and
sufficiently well diversified in terms of risk to warrant offering its own insurance.
Rather than pay insurers a dividend to bear the risk, large employers can simply
assume the risk by budgeting funds to pay medical claims incurred by their employees.
✔✔reinsurance - ✔✔insurance purchased from a private insurance company that allows
self-insured employers to protect themselves against any potential company
✔✔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
