MHA 707 Exam C Study Guide Questions And
Answers Verified 100% Correct
EPO (Exclusive Provider Organization) - ANSWERS A managed care plan where services are
covered only if you go to doctors, specialists, or hospitals in the plan's network (except in an
emergency)
Largest MCO (manager care org) - ANSWERS UnitedHealth Group is the largest with almost
50 M members just over $201 B in revenue.
66% of people under the age of 65 age covered through private insurance
Private health insurance paid about 36% of health consumption
8% of people under the age of 65 were uninsured in 2019
Private health insurance is generally governed by - ANSWERS The state
MCO takes on the risk of contract
Contracts must be approved for sale in each state with the associated regulatory requirements
Larger Employers are typically - ANSWERS Self insured
Employer pays for the actual health care cost of employees
Re-insurance picks up large overruns (Lloyds of London)
Out of Pocket Cost for Patients - ANSWERS Copayments
Coinsurance
Deductibles
Moral Hazard - ANSWERS When the act of insuring an event increases the likelihood that the
event will happen
behaving different when you know someone is taking the risk (induced demand)
Adverse Selection - ANSWERS the situation in which one party to a transaction takes advantage
of knowing more than the other party to the transaction
the sicker people likely want more insurance, compared to those who are healthy
Pooling of Risk - ANSWERS Allows individuals to share risk, i.e., insurance companies
, National Health Expenditure Accounts (NHEA) - ANSWERS Provides official estimates of
health care spending in the US. It measures health care consumption and health care investment.
Copayment - ANSWERS a small fixed fee paid by the patient at the time of an office visit
Coinsurance - ANSWERS a type of insurance in which the insured pays a share of the payment
made against a claim.
Ex 80/20
Deductibles - ANSWERS amounts that must be paid by the patient for medical services before
the policy begins to pay
Medicare Part A - ANSWERS Hospital insurance; also covers some skilled nursing facilities.
No enrollment fee for most and they are charged monthly premium based on number of eligible
quarters they contributed .
Medicare Part B - ANSWERS The part of the Medicare program that pays for physician
services, outpatient hospital services, durable medical equipment, and other services and
supplies.
Medicare Part C - ANSWERS managed care health plans offered to Medicare beneficiaries
under the Medicare advantage program
Medicare Part D - ANSWERS Prescription drug coverage
The significance and Impact of Price - ANSWERS Price: most important driver of HC cost in
US
Technology
Utilization
Medicare Cost Statistics - ANSWERS Medicare was the source of funds for 21% of HCE or
about $706 billion in 2017; estimated average cost per enrollee in Medicare was just over
$12,300 in 2017, the most of any of the major classes of payer
Medicaid Enrollee Statistics - ANSWERS 77% of Medicaid enrollees were nonelderly adults
and children, while 23% were disabled and elderly adults
Medicaid programs 18% of HCE or $582 billion in 2017 and about 62% of that came from the
federal government with the rest split among the 50 states
In 2017, the estimated average insurance cost per enrollee (i.e., excluding out-of-pocket
expenses) was just over $8,000 nationally
Answers Verified 100% Correct
EPO (Exclusive Provider Organization) - ANSWERS A managed care plan where services are
covered only if you go to doctors, specialists, or hospitals in the plan's network (except in an
emergency)
Largest MCO (manager care org) - ANSWERS UnitedHealth Group is the largest with almost
50 M members just over $201 B in revenue.
66% of people under the age of 65 age covered through private insurance
Private health insurance paid about 36% of health consumption
8% of people under the age of 65 were uninsured in 2019
Private health insurance is generally governed by - ANSWERS The state
MCO takes on the risk of contract
Contracts must be approved for sale in each state with the associated regulatory requirements
Larger Employers are typically - ANSWERS Self insured
Employer pays for the actual health care cost of employees
Re-insurance picks up large overruns (Lloyds of London)
Out of Pocket Cost for Patients - ANSWERS Copayments
Coinsurance
Deductibles
Moral Hazard - ANSWERS When the act of insuring an event increases the likelihood that the
event will happen
behaving different when you know someone is taking the risk (induced demand)
Adverse Selection - ANSWERS the situation in which one party to a transaction takes advantage
of knowing more than the other party to the transaction
the sicker people likely want more insurance, compared to those who are healthy
Pooling of Risk - ANSWERS Allows individuals to share risk, i.e., insurance companies
, National Health Expenditure Accounts (NHEA) - ANSWERS Provides official estimates of
health care spending in the US. It measures health care consumption and health care investment.
Copayment - ANSWERS a small fixed fee paid by the patient at the time of an office visit
Coinsurance - ANSWERS a type of insurance in which the insured pays a share of the payment
made against a claim.
Ex 80/20
Deductibles - ANSWERS amounts that must be paid by the patient for medical services before
the policy begins to pay
Medicare Part A - ANSWERS Hospital insurance; also covers some skilled nursing facilities.
No enrollment fee for most and they are charged monthly premium based on number of eligible
quarters they contributed .
Medicare Part B - ANSWERS The part of the Medicare program that pays for physician
services, outpatient hospital services, durable medical equipment, and other services and
supplies.
Medicare Part C - ANSWERS managed care health plans offered to Medicare beneficiaries
under the Medicare advantage program
Medicare Part D - ANSWERS Prescription drug coverage
The significance and Impact of Price - ANSWERS Price: most important driver of HC cost in
US
Technology
Utilization
Medicare Cost Statistics - ANSWERS Medicare was the source of funds for 21% of HCE or
about $706 billion in 2017; estimated average cost per enrollee in Medicare was just over
$12,300 in 2017, the most of any of the major classes of payer
Medicaid Enrollee Statistics - ANSWERS 77% of Medicaid enrollees were nonelderly adults
and children, while 23% were disabled and elderly adults
Medicaid programs 18% of HCE or $582 billion in 2017 and about 62% of that came from the
federal government with the rest split among the 50 states
In 2017, the estimated average insurance cost per enrollee (i.e., excluding out-of-pocket
expenses) was just over $8,000 nationally
