Module 1 Flashcards
Spreading Risk over a large Homogeneous Group
Pooling
An unforeseen, unexpected, non-speculative event
Random Loss
The purchase of insurance when one anticipates having claims.
Adverse Selection
Unneeded health services may be used when the consumer isn’t paying the full cost for them.
Moral Hazard
Requires insureds to pay a certain percentage of eligible medical expenses and the insurance company covers the rest i.e., 20%/80%
Coinsurance
The amount that individuals must pay before their insurance plan starts to pay
Deductible
A cost share expressed as a dollar amount, such as $25 for an office visit.
Copayment
Provides hospital and some skilled nursing facility coverage.
Medicare Part A
Covers physician and similar services
Medicare Part B
Also known as Medicare Advantage Plans
Medicare Part C
Pharmacy
Medicare Part D
A public insurance program that provides health coverage to low-income families and individuals.
Medicaid
A private insurer or a public program, which pays for all or part of a patient’s healthcare services.
Third-party payers
Provide network and non-network choices without need for a PCP (gatekeeper)
Preferred provider organizations (PPO)
Theoretically, they give consumers “skin in the game”.
High-Deductible Health Plans (HDHP)
