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CEBS GBA Exam 2 2024/2025 With 100% Correct Answers
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CEBS GBA Exam 2 2024/2025 With 100% Correct AnswersWhat is the basic assumption underlying concept of a free market and how is it
challenged by the theory of "bounded rationality?" (Mod 1.1) - ✔✔Rational
customers will make informed decisions about value, quality and price, while
producers who meet consumer's demands will be rewarded with market share and
profit.
What are economic benefits of a free market? (Mod 1.1) - ✔✔If an individual does
not like their provider or health plan, the should be able to "vote with their feet" and
select other options. This choice empowers customers, regulates producers and
drives efficiency.
Describe several ways the US Healthcare market does not function like a normal
market. (Mod 1.1) - ✔✔Healthcare market has significant asymmetry in information
between consumers, providers and insurers. Moral hazard is a problem because the
marginal cost of covered care is zero, causing some to over consume medical care.
List several recent initiatives in the US that purport (to claim, often falsely) to use
market forces to increase efficiency in the healthcare system. (Mod 1.1) - ✔✔1)
Employers are offering more HDHPs with some as high as $10,000.
2) ACA is creating marketplaces that employ a form of managed competition where
standardized health plans compete on cost and quality.
3) Public Medicaid and Medicare programs are moving towards requiring or making
choices available for managed care products that structure care within provider
networks.
Indicate the approximate percentages of the population covered by major health
programs. (Mod 1.2) - ✔✔Largest portion of Americans (48%) receive health
insurance through an Employer, 16% through Medicaid, 15% through Medicare, 6%
purchase insurance on their own
,How did ACA change Medicare? (Mod 1.2) - ✔✔ACA expanded Medicare's
wellness and prevention benefits, improved prescription drug coverage and financed
experiments to control health care costs by testing alternative payment methods and
delivery systems.
How did ACA change eligibility for Medicaid benefits? (Mod 1.2) - ✔✔ACA shifted
program eligibility from category based (ex: single parents with dependents or
people w/disabilities) to an income-based standard.
how has the ACA affected the number of people who are enrolled in Medicaid?
(Mod 1.2) - ✔✔Medicaid once covered fewer than half of low-income Americans,
but now ACA Medcaid expansion has been steadily increasing enrollment, with
largest increase in the states who are participating.
Explain significance of US Supreme Court case National Federation of Independent
Business v Sebelius in 2012 (Mod 1.2) - ✔✔ACA sought to expand Medicaid
coverage to all individuals and families with incomes below 138% of the poverty
level. US (first time) would have had a solid safety net of insurance coverage for all
lower income citizens. In the case, the court rules states could choose not to expand
(and Medicaid funding would not be withheld). By Jan 2015, 25 states chose not to
expand.
How has ACA affected number of uninsured Americans? (Mod 1.2) - ✔✔Prior to
ACA, 16.3% or 49.9 million Americans were uninsured. By 2014, this number
reduced to 13% and by the first quarter of 2016 to 8.6%.
Describe private health insurance coverage with regard to a) size of firm
b) HDHPs with Medical Savings Accounts
c) variability of coverage by states (Mod 1.2) - ✔✔a) 98% of employers with 200+
EE's offer health insurance but fewer than 45% of firms with 3-9 EE's do so. Larger
,employers offer more choice of health plans than smaller employers; small
employers tend to offer POS plans that require higher EE cost sharing to go outside
network.
b) In 2006, HDHPs with medical savings accounts accounted for 4% of ER-
sponsored market, but by 2012, accounted for over 20%. In 2016, this rose to almost
30%.
c) Range of ER-based options and quality of options available vary widely by state.
The percentage of the population covered by private insurance varies as well as the
options for different types of coverage.
What are the basic differences between the four medal categories of ACA health
plans? (Mod 1.3) - ✔✔Bronze, Silver, Gold and Platinum plans all have same
actuarial value. However, they differ in regard to amount of deductibles,
coinsurance, other out of pocket costs and premiums. Bronze plan has lowest
premium but most out of pocket costs. Platinum plan has lowest out of pocket cost,
but highest premium.
Why is the Silver Plan the most popular choice among ACA plans? (Mod 1.3) -
✔✔Majority who enroll are eligible for federal tax credit subsidies tied to a Silver
level plan. People may still select a higher cost Gold or Platinum plan, but will have
to pay higher premiums. Cost-sharing subsidies to lower out of pocket costs are only
available to Silver plans.
Do users of ACA marketplace exchanges have many choices? (Mod 1.3) - ✔✔Ton
of choices and options (ex: in TX, 15 carriers offered an average of 31 plans per
county).
Does evidence indicate that consumers choose the most cost-effective medical plan
in the marketplace? (Mod 1.3) - ✔✔people on average choose plan 10% more
expensive than what would be optimal. Other studies suggest limiting variation in
plan designs would be choices more comprehensible (able to understand).
, What is the provision in Part D Medicare law that gives a significant benefit to
pharmaceutical companies? (Mod 1.4) - ✔✔Part D Medicare Law prohibits the
government from using its purchasing power to negotiate widespread discounts with
drug plans.
Do Medicare Part D beneficiaries have many choices and does the evidence suggest
they choose the most cost-effective plans? (Mod 1.4) - ✔✔Provide numerous
choices (ex MA has 27 standalone, TX has 32). Most people do not select the optimal
plan or take advantage of open enrollment periods to obtain a more cost-effective
plan. Few people switch plans even when it would be in their advantage to do so.
Define each part of Medicare (A,B,C,D) and the services provided under each (Mod
1.4 - Reading) - ✔✔Part A = Hospital Services
Part B = Physician & Diagnostic Services
Part C = Medicare Advantage - Alternative Managed Care Option
Part D = Prescription Drugs
-Greatest choices in Part D and the Medicare Advantage Plan, which is where most
of analysis is focused on.
-C and D are paid out of pocket by recipients; A & B are funded by payroll
deductions (taxes)
What is Medicare Part C and why do some people select it? (Mod 1.4) - ✔✔AKA
Medicare Advantage:
-Recipients have the option to enroll in a health plan with a narrowed network of
hospitals and providers that covers Part A and B but with lower out of pocket costs.
These plans often include their own prescription drug coverage. Unlike Part D, this
is a voluntary choice and beneficiaries always have the option of going back to the
traditional plan. It is a choice to restrict options and consolidate the different
elements of Medicare, including cost sharing.
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