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C425 WGU EXAM – Questions & Answers
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C425 WGU EXAM – Questions & Answers
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C425 WGU EXAM – Questions & AnswersMedicare Part A ✔️Ans - Was designed to use Social Security funds to
finance hospital care.
Medicare Part B ✔️Ans - Was designed to cover physicians' services
•Through government-subsidized insurance.
•The elderly would pay part of the premiums.
Medicaid: who is eligible? ✔️Ans - Confines eligibility to those below an
income level
Medicare- who is eligible ✔️Ans - has uniform national standards for
eligibility and benefits.
•It covers anyone over the age of 65.
Three main features of the corporate era ✔️Ans - corporatization,
information revolution, globalization
Corporatization ✔️Ans - medical care has become the domain of large
corporations
Corporate Era ✔️Ans - Information revolution
•Telemedicine
•Integration of telecommunication systems into distant care giving.
•E-health
•Information and services over the Internet.
•Empowered consumers.
Globalization ✔️Ans - Various cross-border activities (information
exchange, goods and services, interdependence of economies)
Sources of financing health care ✔️Ans - Private health insurance
• Public insurance programs such as Medicare and Medicaid
• Uncompensated or charity care
Complexity of financing ✔️Ans - - Many payers
- Many plans
, - Many programs
- Many payment mechanisms
Effects of Financing and Insurance ✔️Ans - -demand for services
-moral hazard
-covered services expand rapidly
-growth of med tech
-provider induced demand
Insurance ✔️Ans - A mechanism to protect against risk.
•Insured (enrollee or beneficiary) ✔️Ans - an individual protected by
insurance
Insurer ✔️Ans - An insurance agency that assumes the risk
Underwriting ✔️Ans - Evaluates, selects/rejects, classifies, and rates
risk.
three main types of cost sharing in private health insurance: ✔️Ans -
Premium cost sharing
•Deductibles
•Copayments
Five main types of private insurance ✔️Ans - group insurance, self
insurance, individual private insurance, managed care plans, high
deductible health plans
Group insurance ✔️Ans - Offered through an employer, a union, or
professional organization.
-Anticipates large numbers of people in a group will buy insurance through
a sponsor.
-Cost and risk are distributed equally among the insured.
Self-insurance ✔️Ans - Large employers' workforces are large and
diversified enough.
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