Question 1

Medicaid is the largest source of funding for medical and health-related services for poor people. Within broad national guidelines established by federal statutes, regulations, and policies, each state must:

Accepted Answer

Each state has the flexibility to establish its own eligibility standards, determine the type, amount, duration, and scope of services, set the rate of payment for services, and administer its own Medicaid program within the broad national guidelines.

Question 2

A client opting to enroll in a point-of-service plan would expect which of the following?

Accepted Answer

A point-of-service plan typically involves primary care physicians making referrals within the network, but if a client chooses to go outside the network, they can expect higher out-of-pocket costs such as increased copayments and deductibles.

Question 3

In 2002, Medicare started to pay qualified _________________ who enrolled in the Medicare program as providers.

Accepted Answer

In 2002, Medicare began reimbursing qualified dietitians who enrolled in the Medicare program as providers.

Question 4

Programs of All-Inclusive Care for the Elderly (PACE) provides an alternative to institutional care for persons ______ and older.

Accepted Answer

PACE provides an alternative to institutional care for persons 55 and older.

Question 5

Mike is receiving services from a state Medicaid program. He will receive all of the following except:

Accepted Answer

Medicaid typically covers medical services such as physician services, vaccines, and nurse/midwife services, but it does not cover non-medical services like housecleaning.

Question 6

Which program provides services to people who are 65 years old, are disabled, or have permanent kidney failure?

Accepted Answer

Medicare is a federal program that provides health coverage for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Question 7

The gaps in Medicare coverage include which of the following?

Accepted Answer

Medicare coverage gaps include copayments, which are the amounts beneficiaries must pay out-of-pocket for certain services after the deductible is met.

Question 8

Which of the following is the main concern regarding the fee-for-service plan?

Accepted Answer

Fee-for-service plans can incentivize providers to offer more treatments and services than necessary, as they are paid for each service rendered, potentially leading to unnecessary care.

Question 9

Which type of fee-for-service plan covers some hospital services and supplies, x-rays, and prescribed medicine?

Accepted Answer

Basic fee-for-service plans typically cover hospital services, supplies, x-rays, and prescribed medicine.

Question 10

Which of the following describes independent groups of physicians that contract with HMOs to provide services to enrollees?

Accepted Answer

The group model involves independent groups of physicians contracting with HMOs to provide services to enrollees, distinguishing it from the staff model where physicians are employed directly by the HMO.

Question 11

Jim has an income that is too high to qualify for state medical assistance and cannot obtain private insurance. He wants his children covered for insurance and doesn't know what to do. Which federal government program was created to help people like Jim?

Accepted Answer

The State Children's Health Insurance Program (SCHIP) was created to provide health insurance to children in families with incomes too high to qualify for Medicaid but too low to afford private coverage.

Question 12

Which act is known as the Welfare Reform Act?

Accepted Answer

The Personal Responsibility and Work Opportunity Reconciliation Act, enacted in 1996, is commonly referred to as the Welfare Reform Act. It aimed to reform the welfare system by promoting work and personal responsibility.

Question 13

Which of the following describes a payment method in which each provider, such as an HMO, receives a flat annual fee for each individual, regardless of how often services are used?

Accepted Answer

Capitation is a payment arrangement where a provider is paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.

Question 14

Stacy needs to apply for Medicare to pay for some of her medical expenses. She needs to go to the ____________ to obtain more information and to apply.

Accepted Answer

The Social Security Administration handles Medicare applications and provides information about Medicare benefits.

Question 15

John recently found out that there are significant gaps in his Medicare coverage. This means that some of his medical services will not be covered, including:

Accepted Answer

Medicare does not cover excess charges by non-participating doctors, certain supplies, long-term nursing care, and custodial care, as well as dental, vision, and hearing services.

Question 16

People in the highest income households are more likely than those in lower income households to report their health status as good.

Accepted Answer

Higher income often correlates with better access to healthcare, healthier lifestyles, and less stress, leading to better self-reported health status.

Question 17

Medicare is the designated health insurance for pregnant and lactating women.

Accepted Answer

Medicare is a federal health insurance program primarily for people aged 65 and older, as well as for some younger individuals with disabilities or specific conditions, not specifically for pregnant and lactating women.

Question 18

The National Center for Health Statistics defines health insurance as a broad term that includes private and public payers who cover medical expenditures incurred by a defined population in a variety of settings.

Accepted Answer

The National Center for Health Statistics defines health insurance as coverage that includes both private and public payers, which covers medical expenses for a specific population across different healthcare settings.

Question 19

Medicare Supplemental Insurance, also known as Medigap, was developed to provide medical coverage to pregnant women.

Accepted Answer

Medicare Supplemental Insurance, or Medigap, is designed to cover gaps in Medicare coverage for expenses like copayments, coinsurance, and deductibles, not specifically for pregnant women.

Question 20

Medicaid provides health care services to low-income persons with family incomes below 133 percent of poverty level, 65 years and older, disabled individuals, infants and pregnant women, and the blind.

Accepted Answer

Medicaid is designed to assist various groups including low-income individuals, the elderly, disabled, infants, pregnant women, and the blind, with eligibility often based on income and other factors.

Quiz 18: Private and Government Healthcare Systems