Healthcare Economics

In a Point of Service (POS) plan, what is required to see a specialist?

• A referral from your primary care provider

• Visiting an in-network physician

• Selecting a primary care provider

• Having coverage for care from an out-of-network provider

In a Preferred Provider Organization (PPO), what happens if you choose an out-of-network provider?

• You have higher out-of-pocket expenses

• You have 100% coverage after the deductible and co-payment

• You must get a referral from your primary care provider

• You can only receive care from providers in the plan's network

What are the most common types of managed care plans?

• EPO, HMO, PPO, and POS

• Indemnity, EPO, PPO, and POS

• HMO, PPO, POS, and Medicare

• Medicaid, Medicare, EPO, and HMO

What is reimbursement in health insurance?

• Reimbursement is when health insurance repays the full amount charged for medical services.

• Reimbursement is when health insurance repays a portion of the amount charged for medical services.

• Reimbursement is when health insurance pays the healthcare provider directly for medical services.

• Reimbursement is when health insurance pays the patient for medical services.

What are the two major differences between managed care and indemnity insurance?

• Managed care plans offer reduced rates for medical services, while indemnity insurance requires patients to pay out-of-pocket and wait for reimbursement.

• Managed care plans require patients to choose from a network of healthcare providers, while indemnity insurance allows patients to receive treatment from any healthcare provider.

• Managed care plans reimburse the full amount charged for services, while indemnity insurance has a set limit for reimbursement.

• Managed care plans do not cover medical expenses for out-of-network providers, while indemnity insurance covers all medical expenses.

What is the primary goal of managed care?

• Promoting good health

• Practicing preventive medicine

• Reducing the cost of medical expenses

• All of the above

What is the deductible in health insurance?

• The amount paid by the patient before the insurance agency will begin to make payments

• The percentage of costs of a healthcare service that are paid by the patient after they have paid the deductible

• A medical bill that must be paid by the patient

• The amount paid to an insurance agency for a health insurance policy

Which type of health insurance plan does not require referrals to see specialists?

• HMO plans

• PPO plans

• POS Plans

• Short-term health plans

PPO

• Preferred Plan Operation
• Preferred Provider Organization
• Preferred Practice Organization
• Preferred Participation Operation

HMO

• Health Maintenance Organization
• Health Managed Organization
• Health Maintained Operation
• Health Managed Operation