#1
Which of the following is a characteristic of managed care organizations (MCOs)?
They emphasize preventive care and cost-effective treatments.
ExplanationMCOs prioritize preventive care and cost efficiency.
#2
What is the main purpose of a health maintenance organization (HMO)?
To provide comprehensive healthcare services for a fixed monthly fee.
ExplanationHMOs offer comprehensive care for a fixed fee.
#3
Which of the following is NOT a type of managed care organization?
Consumer-Directed Health Plan (CDHP)
ExplanationCDHP is not a managed care organization.
#4
Which of the following is a characteristic of a high-deductible health plan (HDHP)?
It typically features higher monthly premiums.
ExplanationHDHPs usually have higher premiums.
#5
Which of the following is NOT a type of cost-sharing in health insurance?
Premium
ExplanationPremium is not a form of cost-sharing.
#6
Which federal program provides health insurance coverage for individuals aged 65 and older?
Medicare
ExplanationMedicare covers healthcare for those 65 and older.
#7
What is a primary feature of a preferred provider organization (PPO)?
It offers a wide network of healthcare providers, giving members the freedom to choose.
ExplanationPPOs provide a broad network of providers.
#8
Which of the following statements best describes a Health Savings Account (HSA)?
An account where individuals can deposit pre-tax dollars to be used for qualified medical expenses.
ExplanationHSAs allow pre-tax funds for medical expenses.
#9
What is the main function of utilization management in managed care?
To assess the appropriateness and necessity of healthcare services provided to patients.
ExplanationUtilization management evaluates service necessity.
#10
Which federal agency regulates managed care organizations in the United States?
Centers for Medicare & Medicaid Services (CMS)
ExplanationCMS oversees managed care organizations.
#11
What is the role of a primary care physician (PCP) in managed care?
To coordinate and manage the overall healthcare of patients, including referrals to specialists.
ExplanationPCPs coordinate patient healthcare.
#12
In the context of health insurance, what does 'co-payment' refer to?
A fixed amount that the insured individual must pay for covered services at the time of service.
ExplanationCo-payment is a fixed fee for covered services.
#13
What is the primary purpose of risk sharing in health insurance?
To transfer financial risk from insurers to policyholders.
ExplanationRisk sharing shifts financial risk to policyholders.
#14
Which of the following factors contributes to the concept of 'adverse selection' in health insurance?
Attracting individuals with pre-existing health conditions to enroll in insurance plans.
ExplanationAdverse selection draws those with pre-existing conditions.