Module 7 lecture, part 2

Question 1

What are not generally included in health insurance?

Answer 1

Vision and dental

Question 2

What percentage is covered by private insurance in the US in 2015?

Answer 2

56%

Question 3

What are the types of private insurance?

Answer 3

Group insurance
Self-insurance
Individual private health insurance
Managed care plans: HMOs, PPOs
High-deductible health plans
Medicap: Medicare Supplement Insurance

Question 4

How can grp insurance be obtained?

Answer 4

Employer
Union
Professional org

Question 5

When does grp insurance have tax advantages?

Answer 5

When obtained through an employer

Question 6

How does a self-insured plan work?

Answer 6

The employer, mostly large businesses, acts as its own insurer

Question 7

What are some benefits of self-insurance?

Answer 7

No premium tax on employers
Exempt from some of the ACA requirements

Question 8

In individual private health insurance, what are premiums based on?

Answer 8

Individual’s health and demographics

Question 9

Employee Retirement Income Security Act of 1974- what are its implications?

Answer 9

Exempts self-insured plans from ACA requirements

Question 10

In what form is most health insurance?

Answer 10

Managed care plans

Question 11

What type of plans are high-deductible plans?

Answer 11

Consumer-driven

Question 12

What are two types of high-deductible plans?

Answer 12

HRA
HSA

Question 13

What does Medigap cover?

Answer 13

The high out of pocket costs in the original Medicare program

Question 14

To whom is Medigap not available to? What does it not cover?

Answer 14

Those covered by Medicaid or Medicare advantage
Long-term care

Question 15

What is the trend of employment-based insurance since 2000?

Answer 15

Continuous decrease in coverage

Question 16

What percentage of private health insurance was health-based in 2005?

Answer 16

91.6%

Question 17

What was the percentage of private health insurance that was employer-based in 2011?

Answer 17

89%

Question 18

Trends in the uninsured

Answer 18

Dramatically increased between 2000 and 2009

Question 19

Premium subsidies from employers have _______, while out of pocket costs have ______.

Answer 19

Decreased, increased

Question 20

What were the increases in premiums for single and family plans between 2008-2013?

Answer 20

Single- 25%
Family- 29%

Question 21

How much have deductibles increased in employment-based insurance between 2008-2013?

Answer 21

From $735 to $1000, $135 on avg

Question 22

ACA compliance requirements

Answer 22

Coverage for young adults under 26 on their parents’ plans
Coverage for pre-existing conditions
Coverage for preventive services without cost sharing
Imposing a fee on insurers for selling plans through the exchanges
No dollar limits on benefits
Limits on out of pocket costs for deductibles and copayments/coinsurance
Required minimum medical lost ratios (MLR)

Question 23

Details about MLR

Answer 23

MLR = % of premium revenue spent on medical expenses
The rest = administration, marketing, and profits
85% for large grp insurance plans
80% for individual/small grp insurance plans

Question 24

Likely effects of MLR

Answer 24

Rise in premiums as a safety cushion

Question 25

What are the conditions of the ACA individual mandate?

Answer 25

All legal residents must have “minimum essential coverage” or pay a penalty tax
Plans must include the essential health benefits in 10 categories

Question 26

What are the exemptions to the ACA individual mandate?

Answer 26

Unaffordability
Religious opposition to insurance
Being a member of a recognized Indian tribe
Exempt from filing income taxes
A coverage gap < 3 mos
Plans purchased at the health insurance marketplace

Question 27

Problems with the ACA individual mandate

Answer 27

The penalty tax is not strong enough
Qualifications for the subsidies is based solely on income