Health Insurance Answers

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3

As a part-time employee, Rachel does not qualify for any benefits from her current employer. Seeing a need for a health care program, Rachel went shopping for health insurance and is trying to decide between two options with a national health insurance provider. The benefits of each option are outlined in the tables below. OPTION 1: Fee-for-service OPTION 2: HMO $225 monthly premium $630 monthly premium $7,500 deductible No annual deductible Co-pays: Co-pays: Name-brand Drugs: $30 Name-brand Drugs: $25 Generic Drugs: $12 Generic Drugs $10 Visits: Visits: Primary Care Physician $30 Primary Care Physician $20 Specialist: $75 Specialist: $62 Urgent Care: $100 Urgent Care: $50 Emergency Room: $250 Emergency Room: $175 The first option is a fee-for-service plan with a $7,500 deductible. Rachel must pay the deductible amount in health-related costs (not including co-pays) before the insurance company will contribute. This plan costs $225.00 per month and requires co-pays for most standard healthcare costs. The second option is an HMO. It is significantly more expensive at $630 per month, but has no annual deductible. The standard co-pays are also less than those in the other option. Rachel is a young lady with very few health care requirements. She anticipates one monthly visit to her primary care physician, and one annual visit to her allergy specialist. She has two generic prescription allergy medicines that need to be filled twice a month. If Rachel is able to stay healthy the entire year and does not accrue any additional health care costs, which of the following statements is true for her situation?

A
The higher co-pays and annual deductible make Option 1 more expensive than Option 2.
B
The higher premium for Option 2 offsets the lower co-pays making the two options the same value.
C
Rachel's health care needs will cost less under Option 1 if she is able to avoid additional health care costs.
D
Even though she pays more monthly, the insurance company will cover more of Rachel's health care costs under option 2.
5

Which of the following health care programs will wait to pay their share of medical coverage until after treatment is provided?

A
fee-for-service plan
B
health managed organization
C
preferred provider organization
D
point-of-service plan
6

Which of the following health care programs will wait to pay their share of medical coverage until after treatment is provided?

A
fee-for-service plan
B
health managed organization
C
preferred provider organization
D
point-of-service plan
8

Health insurance helps to protect you from financial loss by _____.

A
paying for some or all of your medical costs while you are insured.
B
working with medical care providers to minimize or discount the total cost of medical care.
C
connecting you with health care representative to help keep you in good medical condition to avoid excessive medical care costs.
D
informing you about lectures, classes, and presentations that help inform you about maintaining good medical condition to avoid excessive medical care costs.
9

In order to make premiums more affordable for their customers, Leroux Health Insurance is considering some changes to one of the plans they offer. Both the current options and proposed changes are outlined in the charts below. Leroux Health InsurancePlan AProposed Changes Cost: Monthly Premium: $248.00 $203.00 Annual Deductible: $ 5,500.00 $8,500.00 Co-pays: Brand-name Prescriptions $35.00 $30.00 Generic Prescriptions $15.00 $10.00 Visits: Primary Care Physician: $40.00 $30.00 Specialist: $60.00 $45.00 Urgent Care: $125.00 $90.00 Emergency Room: $325.00 $250.00 If Kevin is currently insured under Leroux for his medical insurance under Plan A, how will the proposed changes affect his health care costs?

A
Costs for regularly scheduled health care will go down, but Kevin may end up paying more if he finds himself seriously ill or injured.
B
Costs for regularly scheduled health care will go up, but Kevin will probably pay less than he would have if he finds himself seriously ill or injured.
C
Both the cost for regularly scheduled health care and the cost for emergency health care will go down, making the changes very good for Kevin.
D
Both the cost for regularly scheduled health care and the cost for emergency health care would go up, contradicting the intentions of Leroux Insurance.
13

As a part-time employee, Rachel does not qualify for any benefits from her current employer. Seeing a need for a health care program, Rachel went shopping for health insurance and is trying to decide between two options with a national health insurance provider. The benefits of each option are outlined in the tables below. OPTION 1: Fee-for-service OPTION 2: HMO $225 monthly premium $630 monthly premium $7,500 deductible No annual deductible Co-pays: Co-pays: Name-brand Drugs: $30 Name-brand Drugs: $25 Generic Drugs: $12 Generic Drugs $10 Visits: Visits: Primary Care Physician $30 Primary Care Physician $20 Specialist: $75 Specialist: $62 Urgent Care: $100 Urgent Care: $50 Emergency Room: $250 Emergency Room: $175 The first option is a fee-for-service plan with a $7,500 deductible. Rachel must pay the deductible amount in health-related costs (not including co-pays) before the insurance company will contribute. This plan costs $225.00 per month and requires co-pays for most standard healthcare costs. The second option is an HMO. It is significantly more expensive at $630 per month, but has no annual deductible. The standard co-pays are also less than those in the other option. Rachel is a young lady with very few health care requirements. She anticipates one monthly visit to her primary care physician, and one annual visit to her allergy specialist. She has two generic prescription allergy medicines that need to be filled twice a month. If Rachel is able to stay healthy the entire year and does not accrue any additional health care costs, which of the following statements is true for her situation?

A
The higher co-pays and annual deductible make Option 1 more expensive than Option 2.
B
The higher premium for Option 2 offsets the lower co-pays making the two options the same value.
C
Rachel's health care needs will cost less under Option 1 if she is able to avoid additional health care costs.
D
Even though she pays more monthly, the insurance company will cover more of Rachel's health care costs under option 2.
15

In order to make premiums more affordable for their customers, Leroux Health Insurance is considering some changes to one of the plans they offer. Both the current options and proposed changes are outlined in the charts below. Leroux Health InsurancePlan AProposed Changes Cost: Monthly Premium: $248.00 $203.00 Annual Deductible: $ 5,500.00 $8,500.00 Co-pays: Brand-name Prescriptions $35.00 $30.00 Generic Prescriptions $15.00 $10.00 Visits: Primary Care Physician: $40.00 $30.00 Specialist: $60.00 $45.00 Urgent Care: $125.00 $90.00 Emergency Room: $325.00 $250.00 If Kevin is currently insured under Leroux for his medical insurance under Plan A, how will the proposed changes affect his health care costs?

A
Costs for regularly scheduled health care will go down, but Kevin may end up paying more if he finds himself seriously ill or injured.
B
Costs for regularly scheduled health care will go up, but Kevin will probably pay less than he would have if he finds himself seriously ill or injured.
C
Both the cost for regularly scheduled health care and the cost for emergency health care will go down, making the changes very good for Kevin.
D
Both the cost for regularly scheduled health care and the cost for emergency health care would go up, contradicting the intentions of Leroux Insurance.

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