If an insurer incorrectly estimates an insured person's
premium
, then the insurer will suffer a financial loss.
can appeal to the state insurance commissioner for a
subsidy.
will drop people whose medical expenses exceed their
premium.
None of the above
Medicare Part B (physician and outpatient services) is financed
by
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a premium that is 75 percent subsidized by the government and 25
percent subsidized by the aged.
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a payroll tax on both the employee and the employer.
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a premium that is 100 percent subsidized by the government.
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both a subsidized premium and a payroll tax
The diagnosis-related group hospital payment system changed
hospital incentives by making it more profitable to
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employ physicians.
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admit sicker Medicare patients.
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reduce a patient's length of stay.
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charge more for lab tests.
Medicare is difficult to reform because
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pharmaceutical manufacturers benefit from drug sales under Part
D.
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senior congressional leaders do not want their Medicare benefits
changed.
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the Medicare population is opposed and have high
voting-participation rates.
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Medicare reform would likely increase the federal deficit.
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Medicare is not considered to be a fair redistributive system
because
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Medicare beneficiaries receive large subsidies regardless of how
high their income is.
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low-income Medicare beneficiaries with high out-of-pocket
expenses must enroll in Medicaid.
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low-income employees subsidize high-income Medicare
beneficiaries.
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All of the above
Substituting an income-related voucher for the current Medicaid
system would not achieve the following:
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An income-related voucher would eliminate the large differences
between states in the percentage of their populations eligible for
Medicaid.
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An income-related voucher would reinforce the movement toward
Medicaid managed care, with its emphasis on coordinated care and
incentives to provide care in less costly settings.
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An income-related voucher would provide employees with an
incentive to forego higher pay so that they qualify for the voucher
subsidy.
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An income-related voucher would provide those on Medicaid with
an incentive to take higher-paying jobs because they would only
lose part of their voucher subsidy.
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Most states have shifted their Medicaid beneficiaries into
private Medicaid managed care/HMO plans. What is the advantage to
the state for doing so?
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Medicaid patients are more likely to receive coordinated care
and preventive services.
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By paying HMOs a fixed fee per person per month, states are able
to shift their risk for higher expenditures to a managed care
plan.
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Medicaid patients are more likely to have access to a physician
within the HMO.
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The HMOs have entered the Medicaid market because they believe
they can provide the care less expensively and earn a profit.
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What are some legitimate ways to spend down one's assets to
qualify for Medicaid?
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Fixing up one's house, purchasing a new car, or setting up a
special burial account
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Providing financial gifts to one's children
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Transferring property to one's children
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Setting up special retirement accounts that can be passed on to
children or relatives after seven years
|
How is Medicaid administered?
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By each state, but policy is shared with the federal
government
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By the federal government and coordinated with the states
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By a joint commission composed of federal and state
appointees
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None of the above
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Why were hospitals and physicians willing to participate in an
HMO's provider network?
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Hospitals and physicians developed excess capacity and were
willing to discount their prices for more patients.
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Hospitals and physicians believed that they could reduce medical
costs by joining together to better manage patient care.
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Some states provided hospitals and their employed physicians an
incentive to join or start HMOs to serve their Medicaid
patients.
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b and c
How did early managed care firms achieve their largest
savings?
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By limiting access to very expensive specialty prescription
drugs
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By reducing hospital utilization of its enrollees
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By making enrollees wait long periods to see their primary care
physician
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By limiting enrollees' access to the HMO's specialists
|
Managed care plans differ according to the restrictiveness of
their provider network and access to specialists. Which types of
plans are likely to have the lowest premiums?
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|
Plans that have the largest ratio of primary care physicians to
specialists
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Plans that have the most experience and have been in existence
the longest
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Plans that have the most restrictive/narrow provider network
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Plans that have received the highest quality and outcome
measures
|
QUESTION 20
As part of the Affordable Care Act, health insurance exchanges
were established. What have been the most important
cost-containment approaches used by health plans competing for
insurance exchange enrollees?
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Health plans have used very narrow/limited provider
networks.
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Health plans have dramatically reduced access to new medical
technology.
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Health plans have included large deductibles and out-of-pocket
payments.
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a and c
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