Health Insurance Models and Coverage Structures Quiz

Learn about fee-for-service, HMO, PPO, HDHP, Medicare, and more. Quiz yourself on key concepts in health insurance coverage.

Practice Learn Test

What does an HMO (Health Maintenance Organization) emphasize?

Choice and flexibility in healthcare provider selection.

Preventive care and coordination of healthcare services.

Direct payment to healthcare providers based on services rendered.

High deductibles and lower monthly premiums.

What is a characteristic of a health insurance copayment?

It is a fixed amount paid by the insured individual for covered services.

It is the percentage of covered expenses paid by the insured individual.

It is the maximum amount the insured individual must pay out-of-pocket before the insurance company covers all expenses.

It is the amount the insured individual must pay annually before the insurance company starts covering expenses.

Which of the following statements best describes a health insurance premium?

It is the fixed amount an insured individual pays out-of-pocket for covered services.

It is the percentage of covered expenses paid by the insured individual.

It is the maximum amount the insured individual must pay out-of-pocket before the insurance company covers all expenses.

It is the amount an insured individual pays to the insurance company in exchange for coverage.

What is the purpose of Medicaid?

To provide health insurance coverage for individuals aged 65 and older.

To provide health insurance coverage for low-income individuals and families.

To provide health insurance coverage for military service members and their families.

To provide health insurance coverage for individuals with pre-existing conditions.

Which of the following is a characteristic of a Health Maintenance Organization (HMO)?

Insured individuals have the flexibility to see any healthcare provider without referrals.

Coverage is limited to a network of healthcare providers.

Insured individuals pay higher premiums for greater flexibility in provider choice.

There are no requirements for preventive care services.

Which of the following best describes the fee-for-service model in health insurance?

Healthcare providers are paid a fixed amount per patient regardless of the services provided.

Insured individuals pay a set monthly premium for coverage and receive care from a network of providers.

Healthcare providers are paid based on the number and type of services provided to patients.

Insured individuals pay for medical expenses out-of-pocket and are reimbursed by the insurance company later.

In a PPO (Preferred Provider Organization), what is a key feature regarding provider choice?

Insured individuals must obtain referrals from primary care physicians to see specialists.

Insured individuals have more flexibility in choosing healthcare providers, including specialists, within or outside the network.

Insured individuals receive care only from providers within the network.

There is no coverage for out-of-network care.

What is a characteristic of a high-deductible health plan (HDHP)?

Low out-of-pocket expenses for insured individuals.

Coverage for preventive care with no out-of-pocket costs.

Lower premiums but higher deductibles compared to traditional health plans.

No limit on out-of-pocket expenses for insured individuals.

What is the main purpose of a health insurance deductible?

To determine the monthly premium amount.

To limit the total amount an insured individual is required to pay out-of-pocket.

To set the maximum coverage limit for the insurance policy.

To establish the initial amount an insured individual must pay before the insurance company starts covering expenses.

#10

Which of the following is an advantage of a Health Savings Account (HSA)?

Contributions are not tax-deductible.

Funds can only be used for medical expenses incurred during the current calendar year.

Unused funds can roll over from year to year and earn interest tax-free.

Withdrawals for non-medical expenses are tax-free after age 65.

#11

Which of the following is true regarding Medicare Part D?

It covers hospital stays and inpatient care.

It provides coverage for prescription drugs.

It is only available to individuals aged 65 and older.

It covers all healthcare expenses for individuals with low income.

#12

What is the purpose of Medicare Part C, also known as Medicare Advantage?

To provide coverage for prescription drugs.

To provide coverage for long-term care services.

To offer an alternative way to receive Medicare benefits through private health insurance plans.

To cover out-of-pocket expenses for low-income individuals.

#13

What is a Health Reimbursement Arrangement (HRA)?

A tax-exempt trust or custodial account set up to pay for qualified medical expenses.

A savings account linked to a high-deductible health plan (HDHP) to cover out-of-pocket medical expenses.

A type of health insurance plan where employees pay for medical expenses out-of-pocket and are reimbursed by the employer.

A type of health insurance plan where the employer reimburses employees for premiums paid for individual health insurance coverage.

#14

Which of the following is typically covered by Medicare Part A?

Prescription drugs

Outpatient hospital services

Physician services

Skilled nursing facility care