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Current State Of Healthcare Financing- PHCY 609 Exam Study Guide
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Current State Of Healthcare Financing- PHCY 609 Exam Study Guide ...
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Current State Of HealthcareFinancing- PHCY 609 Exam
Study Guide
The four basic modes of paying for health care - Answer out-of-pocket payment
individual private insurance
employment-based group private insurance government financing
private health insurance - Answer With private health insurance, a third party, the
insurer is added to the patient and the health care provider, who are the two basic
parties of the health care transaction. While the out-of-pocket mode of payment is
limited to a single financial transaction, private insurance requires two transactions—a
premium payment from the individual to an insurance plan (also called a health plan),
and a payment from the insurance plan to the provider
Individual private insurance. A third party, the insurance plan (health plan), is added,
dividing payment into a financing component and a payment component. The ACA
added an individual coverage mandate for those not otherwise insured and federal
subsidy to help individuals pay the insurance premium.
Out-of-pocket expense - Answer Out-of-pocket payment is made directly from patient to
provider
the best definition of the term "health insurance premium" - Answer the amount health
insurance companies charge each month for coverage
With your health insurance policy, hospital expenses are subject to a $1,000 deductible
and $250/day copay. Suppose you are hospitalized for 4 days, and the bill (after
insurance) comes to $6,000. How much of that will you have to pay yourself? - Answer
$1000 deductible + $250 x 4 days
$2000
True or False: Medicaid is a government-run health care delivery system, and provides
enrollees access to public health care facilities only - Answer False
Medicaid is government financed by federal (50 - 75%) and state government
provide access to public and private health care facilities
access to care and outcomes down due to providers dropping out
, Which of the following services are not generally covered by Medicare? Part A and B -
Answer dental
eye exams and eyeglasses
hearing aids
long-term services and support
all of the above (CORRECT)
care for 65 year olds and above
Private Health Insurance - Answer Health insurance plans marketed by the private
health insurance industry, as opposed to government-run insurance programs
individual or thru employers
Health insurance plans marketed by private corporations. Source of financing for
approximately 49% of U.S. population
•Private health insurers often collaborate with employers, Medicaid and Medicare to
provide services to varying degrees
•Most people in the US receive health insurance through their employment
•Those receiving employer sponsored private health insurance are subsidized by the
government in the form of tax incentives
Employer sponsored health plans can either be self-funded or fully-insured
youngest, healthiest, most active
incentive of getting an employee (retention) and tax incentive why employers provide
insurance
Medicaid - Answer A program that provides health coverage to millions of Americans,
and is administered by states, according to federal requirements. The program is
funded jointly by states and the federal gov.
pregnant women in poverty
children in poverty
parents with children in poverty
Public health insurance for people with low incomes.
Source of financing for approximately 20% of U.S. population
•70 million+ Americans are covered by this program -
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