Health Insurance Flashcards
6 cards from real CBCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Health Insurance flashcards as text
What is a deductible in a health insurance plan?
Answer: The amount the insured must pay out-of-pocket before the insurance begins paying
A deductible is the amount a patient must pay for covered services before the insurance company begins sharing costs. Most preventive care services are exempt from deductibles under the ACA.
What is the difference between HMO and PPO insurance plans?
Answer: HMOs require a primary care physician and referrals and limit care to network providers; PPOs allow more flexibility with higher out-of-pocket costs for out-of-network care
HMOs (Health Maintenance Organizations) coordinate care through a PCP and require referrals to specialists, with coverage limited to the network. PPOs (Preferred Provider Organizations) offer more flexibility, allowing patients to see any provider but with higher costs for out-of-network care.
What is Medicare Part B primarily designed to cover?
Answer: Medical insurance for outpatient services, physician visits, and preventive care
Medicare Part B is the medical insurance component that covers outpatient services, physician services, preventive care, durable medical equipment, and some home health services.
What is the purpose of the Medicare Summary Notice (MSN)?
Answer: To inform Medicare beneficiaries of claims processed on their behalf, amounts billed, Medicare payment, and patient responsibility
The Medicare Summary Notice is a statement sent to beneficiaries summarizing claims processed during a given period, including what was billed, what Medicare paid, and what the beneficiary may owe.
What does 'prior authorization' (pre-authorization) mean in insurance billing?
Answer: Advance approval from an insurance company required before certain services can be provided
Prior authorization is advance approval required by some insurance plans before certain services, medications, or procedures can be performed. Without it, coverage may be denied.
What is Medicaid?
Answer: A joint federal-state program providing health coverage to low-income individuals and families
Medicaid is a joint federal-state program that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.