Health Insurance Flashcards
5 cards from real EXAMFX practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 5 Health Insurance flashcards as text
What does a Health Maintenance Organization (HMO) require from its members?
Answer: Use of in-network providers only, except in emergencies
Medicare is a federal health insurance program primarily designed for individuals aged 65 or older, as well as certain younger people with disabilities and those with End-Stage Renal Disease. Medicaid, on the other hand, provides health coverage to low-income individuals and families.
What is the purpose of coinsurance in a health insurance policy?
Answer: To share medical costs between the insured and the insurer after the deductible is met
A pre-existing condition refers to a medical illness, injury, or health condition that an individual had or was diagnosed with before their health insurance policy became effective. Historically, insurers could deny coverage or charge more for these conditions, though the Affordable Care Act (ACA) largely changed these rules for most plans.
Which government program primarily provides health insurance for individuals aged 65 and older?
Answer: Medicare
Medicare is a federal health insurance program designed for individuals aged 65 and older, as well as certain younger people with disabilities or specific medical conditions. Medicaid, on the other hand, is for low-income individuals and families.
What is a pre-existing condition in the context of health insurance?
Answer: A medical condition that existed before the health insurance policy became effective
A pre-existing condition is any medical condition diagnosed or treated before the health insurance policy started. The Affordable Care Act prohibits insurers from denying coverage or charging higher premiums due to pre-existing conditions.
What is the primary function of a health insurance deductible?
Answer: To require the insured to pay a specified amount before insurance coverage begins
A health insurance deductible is the specific amount of money the insured must pay out-of-pocket for medical expenses before their insurance plan starts to cover costs. Its primary function is to share the financial responsibility between the policyholder and the insurer, ensuring the insured has a stake in their healthcare costs. This mechanism helps to reduce unnecessary claims and control overall healthcare spending.