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
| | a premium that is 75 percent subsidized by the government and 25 percent subsidized by the aged. |
| | a payroll tax on both the employee and the employer. |
| | a premium that is 100 percent subsidized by the government. |
| | both a subsidized premium and a payroll tax The diagnosis-related group hospital payment system changed hospital incentives by making it more profitable to | | employ physicians. | | | admit sicker Medicare patients. | | | reduce a patient's length of stay. | | | charge more for lab tests. Medicare is difficult to reform because | | pharmaceutical manufacturers benefit from drug sales under Part D. | | | senior congressional leaders do not want their Medicare benefits changed. | | | the Medicare population is opposed and have high voting-participation rates. | | | Medicare reform would likely increase the federal deficit. | Medicare is not considered to be a fair redistributive system because | | Medicare beneficiaries receive large subsidies regardless of how high their income is. | | | low-income Medicare beneficiaries with high out-of-pocket expenses must enroll in Medicaid. | | | low-income employees subsidize high-income Medicare beneficiaries. | | | All of the above Substituting an income-related voucher for the current Medicaid system would not achieve the following: | | An income-related voucher would eliminate the large differences between states in the percentage of their populations eligible for Medicaid. | | | 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. | | | An income-related voucher would provide employees with an incentive to forego higher pay so that they qualify for the voucher subsidy. | | | 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. | Most states have shifted their Medicaid beneficiaries into private Medicaid managed care/HMO plans. What is the advantage to the state for doing so? | | Medicaid patients are more likely to receive coordinated care and preventive services. | | | 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. | | | Medicaid patients are more likely to have access to a physician within the HMO. | | | The HMOs have entered the Medicaid market because they believe they can provide the care less expensively and earn a profit. | What are some legitimate ways to spend down one's assets to qualify for Medicaid? | | Fixing up one's house, purchasing a new car, or setting up a special burial account | | | Providing financial gifts to one's children | | | Transferring property to one's children Setting up special retirement accounts that can be passed on to children or relatives after seven years | How is Medicaid administered? | | By each state, but policy is shared with the federal government | | | By the federal government and coordinated with the states | | | By a joint commission composed of federal and state appointees | | | None of the above | Why were hospitals and physicians willing to participate in an HMO's provider network? | | Hospitals and physicians developed excess capacity and were willing to discount their prices for more patients. | | | Hospitals and physicians believed that they could reduce medical costs by joining together to better manage patient care. | | | Some states provided hospitals and their employed physicians an incentive to join or start HMOs to serve their Medicaid patients. | | | b and c How did early managed care firms achieve their largest savings? | | By limiting access to very expensive specialty prescription drugs | | | By reducing hospital utilization of its enrollees | | | By making enrollees wait long periods to see their primary care physician | | | 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? | | Plans that have the largest ratio of primary care physicians to specialists | | | Plans that have the most experience and have been in existence the longest | | | Plans that have the most restrictive/narrow provider network | | | 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? | | Health plans have used very narrow/limited provider networks. | | | Health plans have dramatically reduced access to new medical technology. | | | Health plans have included large deductibles and out-of-pocket payments. | | | a and c | | | | | |