Hell

1. [IO of Health-1] An insurer designs a narrower network (law permits selective contracting). What outcomes are most consistent with Gaynor, Ho, and Town?

All else equal, it could support lower premiums.

It may strengthen the insurer’s ability to credibly threaten exclusion in bargaining

2. [MHIU-3] (Exactly One Correct Answer) In the MHIU framework, the initial trigger that sets off the premium spiral is:

Higher utilization by subsidized enrollees because their out-of-pocket prices are low.

3. [MHIU-13] In community-rated markets, MHIU raises premiums through which channels?

Average claims increase when subsidized utilization rises.

Healthy unsubsidized exits reduce cross-subsidy from low-cost members.

4. [RAND HIE-9] When did the RAND HIE occur?

1970s

1980s

5. [Lecture Game-29] A hospital increases the prices for privately insured patients to make up for the losses incurred from treating Medicaid patients. What does this scenario illustrate?

Cost-shifting

6. [Pharmaceutical Formularies and Rebates-17] Why is complete exclusion of widely used statins rare in practice, even if powerful in theory?

PBMs compete to offer attractive coverage to employer clients

Employers value breadth of coverage for their members

7. [Lecture Topics 5-6-19] (Exactly One Correct Answer) Under ERISA, which of the following statements is true regarding the ability to sue for wrongful denial of services under covered plans

Individuals can sue only under federal law.

8. [Lecture Topics 5-6-5] Which of the following is/are true about Medicare Part B?

It offers a voluntary medical insurance program.

9. [Bankruptcy as Implicit Health Insurance-18] (Exactly One Correct Answer) Two uninsured patients receive $15,000 bills.

Patient X has $2,000 in non-exempt assets; Patient Y has $20,000. Who, on average, faces higher out-of-pocket liability for the large bill?

Patient Y

10. [RAND HIE-2] (Exactly One Correct Answer) The experiment showed that cost sharing mainly influenced which aspect of outpatient versus inpatient care?

The frequency of routine doctor visits compared with hospital admissions

11. [Lecture Topic 4-130] (Exactly One Correct Answer) A mid-sized employer asks an insurer to set next year’s premium by examining the group’s past claims experience. The insurer quotes the premium in advance and will absorb any losses if the rate turns out to be too low. Which of the following best identifies the premium-setting method being used here?

This is prospective experience rating, because the insurer examines past claims experience to set a premium in advance

12. [Lecture Game-3] When Medicare reimbursement drops below cost, which of the following actions reflect optimal hospital strategy?

Refuse to accept any offers from private insurers below cost

Increase negotiated rates with private insurers to offset Medicare losses

13. [Lecture Topic 4-123] (Exactly One Correct Answer) A commercial health plan develops practice guidelines specifically for the use of biologic immunosuppressants in inflammatory bowel disease. The guidelines establish narrow criteria under which biologics are deemed appropriate, and physicians who prescribe inflammatory bowel disease biologics outside these criteria more than 10% of the time are moved to a lower tier in the plan’s network so their patients face meaningfully higher cost-sharing. All other specialty medications, including biologics for comparably costly conditions such as rheumatoid arthritis and psoriasis, are governed by broader and more permissive guidelines. Which of the following best describes the tool and its implications for cream-skimming?

This is a physician profiling and practice guideline program applied selectively to a single high-cost patient population, which the insurer can use to cream-skim because the tiered network penalty for biologic prescribers effectively steers the sickest inflammatory bowel disease patients, who are the ones most likely to need biologics, away from the plan without the insurer ever directly targeting enrollees.

14. [Lecture Topics 5-6-37] How can insurers have an underwriting loss on their comprehensive hospital and medical lines but make a profit?

They can make up their loss on other lines.

They can make up their loss through positive investment returns.

15. [Lecture Topic 4-151] (Exactly One Correct Answer) How does the “reasonable alternative standard” requirement in standards-based wellness programs affect an insurer’s ability to cream-skim?

It slightly limits cream-skimming potential because insurers cannot fully lock out high-risk enrollees but it does not eliminate the cream-skimming incentive

16. [Agents and Brokers-7] Which policy moves are described as potentially fostering broker competition?

Licensing reciprocity or standardization across states Easing entry barriers that limit brokers in low-competition markets

17. [Lecture Topics 5-6-27] Which of the following correctly explains how CDHPs work?

Combine health savings accounts with high-deductible plans

Provide catastrophic coverage for the consumer

18. [Lecture Topic 4-42] (Exactly One Correct Answer) Who is the largest financer of medical services in the U.S. according to the lecture figures?

Medicare and Medicaid

19. [Lecture Topic 4-44] (Exactly One Correct Answer) What correctly describes the problem that large numbers of uninsured create for hospitals?

Hospitals can face under-reimbursement that harms their finances

20. [MHIU-12] (Exactly One Correct Answer) The outcomes of MHIU (rising premiums, healthy exits) resemble adverse selection, but the initiator differs because MHIU is triggered by:

Subsidy-induced utilization changes rather than selection on risk at purchase.

21. [Lecture Topics 5-6-2] Which of the following is/are true about the Medicare program?

Medicare Part D covers prescription drugs.

22. [MHIU-8] (Exactly One Correct Answer) A university lets Pell-eligible students face near-zero copays at the campus clinic, but charges a uniform, optional health fee. Using the MHIU lens, which outcome is most likely if many non-Pell students can opt out?

Average costs rise; the fee goes up; opt-outs among non-Pell students increase; the pool destabilizes.

23. [Lecture Topic 4-152] (Exactly One Correct Answer) In the Massachusetts Network Health example discussed in lecture, Network Health dropped two premier hospitals from its network in 2012. What was the primary reason costs per enrollee fell so sharply?

The most expensive enrollees voluntarily left the plan because they anticipated needing those hospitals, improving the risk pool through self-selection

24. [Lecture Topic 4-59] Which of the following are variable payment reimbursement systems? Select all that apply.

Percentage of charges

Pay-for-performance

Fee-for-service

Resource-based relative value scale (RBVS)

25. [Agents and Brokers-20] (Exactly One Correct Answer) Match the concepts to the scenarios: Scenario X: Choosing among many plan designs without perfectly predicting future health needs. Scenario Y: The hours of outreach and spreadsheeting needed to assemble comparable quotes.

A) X=Imperfect information; Y = Search frictions

26. [Agents and Brokers-15] Why can more intense broker-to-broker competition reduce commission-driven bias?

Greater risk of client churn if value isn’t delivered

Employers can more easily switch among multiple eager brokers

28. [Lecture Topics 5-6-77] Under the ACA, which of the following would not be allowed as a basis for setting premiums for small group plans?

Industry type

29. [Pharmaceutical Formularies and Rebates-12] About the demand model used for statins, which statements are accurate?

There are no switching costs

Statins are modeled as unrelated goods (no substitution)

Retail vs mail order channel is irrelevant

Demand is modeled as directly responding to list prices paid by manufacturers

None of the above.

30. [Lecture Game-40] An insurance company offers a new plan with a low deductible and high premiums. What does this scenario illustrate?

Adverse Selection

31. [Lecture Topic 4-134] (Exactly One Correct Answer) A firm using retrospective experience rating buys insurance stating that if any one covered employee’s claims exceed a specified dollar threshold during the year, the insurer will cover the excess above that threshold. Which of the following best describes this arrangement?

This is individual stop-loss coverage, because it protects the firm against unusually high claims generated by any one covered person.

32. [Lecture Topic 4-29] (Exactly One Correct Answer) Why does the purchaser’s demand for healthcare still have a limit, even if care were free at the point of service?

There are other costs, such as time

33. [Lecture Game-20] (Exactly One Correct Answer) The lecture describes Iowa as a ’low DSH state.’ What does this mean in practice?

Iowa receives far less in federal DSH aid relative to other states

34. [Lecture Topic 4-131] (Exactly One Correct Answer) A large firm opens a checking account from which an insurer pays employees’ medical claims as they arrive. The insurer charges an administrative fee to run the plan, and if prepayments are not enough to cover claims, the firm is responsible for the shortfall. Which of the following best identifies the premium-setting method being used here?

This is retrospective experience rating, because the firm prepays into an account, the insurer adjudicates and pays

35. [Lecture Topic 4-76] (Exactly One Correct Answer) A health plan offers a premium discount to employees who attend a smoking-cessation seminar, regardless of whether they actually quit smoking. Which of the following best describes the tool being used here?

This is an example of a participation-based wellness program, which the insurer would have difficulty using to cream skim because the discount is tied to participation rather than actually improving health.

36. [Lecture Topic 4-112] (Exactly One Correct Answer) A health plan offers members a 20% reduction in their monthly premium if they provide annual documentation that their BMI is below 27, their LDL cholesterol is below 130 mg/dL, and they are non smokers. Members who do not meet all three criteria receive no discount and pay the standard premium. Documentation must be verified by a physician and submitted each year during open enrollment. Which of the following best describes the tool and its implications for cream-skimming?

This is a standards-based wellness program, which the insurer can use to cream-skim because the outcome thresholds systematically exclude less healthy members from the premium discount, making the plan most attractive to enrollees who are already healthy enough to qualify and unattractive to those who know they cannot

37. [Lecture Topics 5-6-53] Who generally became eligible for Medicaid under its ACA expansion?

Individuals with incomes up to 138% of the federal poverty level.

38. [RAND HIE-1] (Exactly One Correct Answer) Which characteristic of the research design of the “RAND Health Insurance Experiment” most contributes to its ability to draw causal conclusions about cost sharing and health-care use?

It randomly assigned families to different insurance plans

39. [Lecture Topic 4-110] (Exactly One Correct Answer) A maternity case is paid as one flat amount that covers the labor and delivery admission, physician services, and routine postpartum follow-up, regardless of the exact number of services used during that episode. Which of the following best describes the payment system being used here?

This is a fixed payment system called bundled payment.

40. [Lecture Topic 4-62] (Exactly One Correct Answer) Which reimbursement system pays providers separately for each service rendered?

Fee-for-service

41. [IO of Health-19] Which Affordable Care Act (ACA) mechanisms listed below are true?

More data availability made evaluation of reforms easier.

Provider-side policies encouraged consolidation/integration (e.g., ACOs).

Exchanges were intended to boost competition among insurers.

42. [Arrow Health Economics-11] Arrow identifies which factors as drivers of health-care market failure?

Uncertainty of illness incidence

Public-health externalities

Information asymmetry

43. [Lecture Topic 4-146] Which of the following are examples of third-party payers rather than sponsors, providers, or patients? Select all that apply.

CMS/Medicare.

A pharmacy benefit manager such as CVS Caremark.

BlueCross BlueShield.

44. [Lecture Game-33] Hospital A notices that a significant portion of its patients are uninsured. To compensate for the financial loss, they increase the cost of MRI scans for privately insured patients. What does this scenario illustrate?

Cost-shifting

45. [Lecture Topic 4-95] Which of the following pairings are matched correctly?

This is an example of prior authorization applied broadly, which is generally closer to cost control than cream skimming.

This is an example of disease management, which can sometimes function as cream-skimming if it disproportionately

46. [Lecture Topic 4-105] (Exactly One Correct Answer) A physician submits separate bills for an office visit, an X-ray, a blood test, and a joint injection, and the insurer reimburses each service separately. Which of the following best describes the payment system being used here?

This is a variable payment system called fee-for-service.

47. [Lecture Topics 5-6-14] Why did BCBS lose market share in the 1950s and 1960s?

Experienced an adverse selection death spiral.

BCBS used community rating while commercial insurers used experience rating.

BCBS had difficulty breaking in with employers

48. [Lecture Topic 4-41] (Exactly One Correct Answer) Which statement best describes a challenge related to healthcare production?

Uncertainty in diagnosis and treatment can lead to incorrect or unnecessary care that is costly

49. [Lecture Game-1] (Exactly One Correct Answer) Under the baseline conditions of the game (Medicare reimburses above cost, no EMTALA, high administrative networking costs), why should hospitals never negotiate a rate below cost with private insurers?

The next-best alternative available to hospitals reimburses exactly at cost, so there is no incentive to accept less

50. [Lecture Topic 4-31] (Exactly One Correct Answer) The principal-agent problem in healthcare refers to which of the following?

Providers not acting in the best interest of the payer that relies on them

51. [IO of Health-12] Downstream effects of insurer market power

May encourage substitution toward nurses relative to doctors

Often accompanies a decline in the number of active carriers

Can push down physician earnings

Associated with higher premiums in many markets

52. [Lecture Topics 5-6-67] Which of the following could be a potential impact of Medicaid expansion under the ACA on private insurers?

Reduced market share and negotiating power for private insurers if the crowd-out rate is high, limiting insurers’

53. [Lecture Topic 4-88] (Exactly One Correct Answer) A plan requires insurer approval before certain expensive imaging studies will be covered, and the rule applies broadly across enrollees as a way to reduce unnecessary care. Which of the following best describes the tool being used here?

This is an example of prior authorization, which the insurer would usually have difficulty using to cream-skim because it is generally applied broadly as cost control.

54. [Lecture Topics 5-6-29] (Exactly One Correct Answer) A health insurer collects $8,500,000 in premiums, spends $40,000 on case management, $50,000 on discharge planning, $1,000,000 in salaries, $6,500,000 in claims, $400,000 in taxes, and $500,000 on marketing. Say that this is a large group plan. Does this meet the medical loss ratio under the Affordable Care Act?

No, the ACA MLR is 81.36%, which does not meet the minimum medical loss ratio.

55. [Lecture Topics 5-6-88] (Exactly One Correct Answer) In the context of Medicare Advantage, what is the principal-agent problem that leads to upcoding?

Private insurers act as agents collecting risk-adjusted payments from Medicare but have an incentive to overstate enrollee risk to maximize those payments.

56. [Lecture Topics 5-6-20] (Exactly One Correct Answer) How does ERISA apply to stop-loss insurance for self-insured plans?

The relationship is unclear.

57. [Lecture Topics 5-6-34] (Exactly One Correct Answer) A health insurance plan collects $10,000,000 in premiums and spends $7,500,000 on claims, $200,000 on patient-centered education, $1,000,000 on salaries, $100,000 in medication management ac tivities, $400,000 on marketing, $200,000 on the adjudication process, $100,000 on care coordination, $400,000 on taxes and $100,000 on regulatory fees. This is a large group plan. What is the administrative expense ratio under the Affordable Care Act?

16%

58. [Lecture Game-21] (Exactly One Correct Answer) DSH payments were originally created primarily in order to:

Compensate hospitals for losses resulting from disproportionate exposure to Medicare and Medicaid underpayments and uncompensated care

59. [Healthcare Fraud-1] A state suddenly sees explosive billing for “advanced wound care” by new clinics. Which fraud fingerprints (emphasized around Ambulance Taxis) would most warrant urgent review?

Individual clinicians billing hours that exceed plausible annual work time

A steep, exponential run-up in category spending

Many new suppliers entering at once with very similar billing patterns

60. [Lecture Topic 4-46] Which of the following characteristics of the uninsured population were emphasized in the lecture? Select all that apply.

More than two-thirds of the uninsured have been uninsured for a year or more

The highest concentration of uninsured individuals is in the South and West

Most uninsured families have at least one family member who works

62. [MHIU-2] Which features are necessary for MHIU to operate as laid out in the paper’s framework?

A segment of unsubsidized buyers paying full “sticker” premiums.

Community rating that spreads average costs across the pool.

Generous cost-sharing reductions that materially cut marginal prices for low-income enrollees.

63. [Lecture Topics 5-6-94] (Exactly One Correct Answer) An insurer on the ACA exchange successfully cream-skims and ends up with a much healthier-than-average risk pool. What happens under the risk adjustment program?

The insurer must make payments to other plans with higher actuarial risk, reducing the financial reward from cream skimming.

64. [Bankruptcy as Implicit Health Insurance-14] Two identical low-wealth households live in different states: one in Kansas (generous exemptions) and one in Delaware (tight exemptions). Holding income constant, which household would the model push toward a higher optimal Pigouvian penalty for being uninsured?

Kansas household (fewer seizable assets → higher externality → higher optimal penalty)

65. [RAND HIE-5] (Exactly One Correct Answer) Within this study, the term “welfare loss” refers to which phenomenon?

Societal inefficiency when generous coverage encourages use of care worth less than its cost

66. [Healthcare Fraud-16] Which statements about Social Security administration are true?

It is rampantly defrauded due to severe information asymmetry

Payments rely mostly on self-reported symptoms

It relies primarily on provider attestations to set benefits

FCA whistleblowers often sue Social Security claimants

None of the above.

67. [Lecture Game-5] (Exactly One Correct Answer) Why would insurers accept higher hospital costs resulting from cost-shifting rather than simply dropping those hospitals from their network?

Insurers want consumers to purchase their insurance, which requires offering attractive hospital networks

68. [Lecture Topics 5-6-17] (Exactly One Correct Answer) How does the business of insurance play into ERISA?

States that only insured plans can be regulated by state authority pertaining to the business of insurance.

69. [IO of Health-3] When prices are negotiated, what can happen?

New Jersey price deregulation was associated with higher AMI mortality.

If competition focuses on price and patients poorly perceive quality, quality may fall

70. [Lecture Game-44] Which of the following is(are) an incorrect description(s) of charity hazard?

Charity hazard occurs when free healthcare services lead to an increase in risky behavior

71. [RAND HIE-3] In the experiment, how did preventive services such as check-ups respond to changes in cost sharing?

They were as price-sensitive as other outpatient services

72. [RAND HIE-15] Which statement accurately reflects the elasticity findings?

Site-specific elasticities diverged so much that no overall conclusion was possible

Elasticity matched that of discretionary consumer electronics

Demand was perfectly elastic, falling to zero when prices rose

Outpatient demand increased as coinsurance rose

None of the above.

73. [Lecture Topic 4-97] (Exactly One Correct Answer) A Medicaid managed care plan identifies all members with a documented diabetes diagnosis at the time of enrollment and automatically assigns each one a dedicated nurse care coordinator. The coordinator proactively calls all assigned members monthly (including those with multiple comorbidities) and printed educational materials on nutrition, blood sugar monitoring, and foot care are mailed to all enrollees. There are no participation requirements, no digital access requirements, and no benefits that are contingent on engagement. Which of the following best describes the tool being used here?

This is a disease management program, which the insurer cannot use to cream-skim because automatic universal enrollment and proactive outreach eliminate the self-selection mechanism that cream-skimming requires.

74. [Lecture Topic 4-140] (Exactly One Correct Answer) Which of the following best explains the asymmetric information problem in the production of healthcare?

Production involves moral hazard in the form of the principal-agent problem, because insurers and patients must rely on providers to make treatment decisions and providers know more about the appropriate care.

75. [Lecture Topics 5-6-1] Which correctly identify changes brought about the Inflation Reduction Act?

It allowed Medicare to negotiate prescription drug costs.

76. [Healthcare Fraud-2] A county considers paying for non-emergency transports for chemotherapy patients. Based on the medical-necessity logic formalized in Ambulance Taxis, which conditions support coverage?

The patient is bed- or chair-bound, making other transport unsafe

A physician’s certification documents why ambulance is the only safe option

77. [Lecture Topic 4-10] An insurer now requires prior authorization for certain high-cost services before they will be covered. Which strategy/strategies is/are the insurer using?

Consumer management strategies

Provider management strategies

78. [Arrow Health Economics-3] (Exactly One Correct Answer) Which source of market failure is highlighted as justifying policy intervention?

Information asymmetry between patient and physician

79. [Lecture Topic 4-20] (Exactly One Correct Answer) Which statement best reflects the lecture’s treatment of pay-for performance bonuses?

The lecture treats them cautiously because some apparent improvements may be misleading, and later evidence may show little real effect

80. [Lecture Topic 4-86] (Exactly One Correct Answer) A plan requires patients to obtain a referral before seeing a specialist. Which of the following best describes the tool being used here?

This is an example of referral requirements, which the insurer can use to cream-skim because the plan becomes less

81. [Lecture Topic 4-3] (Exactly One Correct Answer) Medication adherence programs, like pill packs, fall under which feature of health insurance?

Consumer management strategies

82. [Lecture Topic 4-98] (Exactly One Correct Answer) A health plan offers members with a hypertension diagnosis a $75 gift card if they download the plan’s app and successfully log taking their blood pressure medication on at least 80% of days over a 6-month period. Enrollment is voluntary, participation requires a smartphone with internet access, and members who fail to reach the 80% threshold receive no reward. Which of the following best describes the tool being used here?

This is a standards-based medication adherence program, which the insurer can use to cream-skim because the outcome threshold and digital access requirements will disproportionately attract lower-cost, more health-engaged hypertensive enrollees.

83. [Lecture Topics 5-6-87] Which of the following is/are true about upcoding in Medicare Advantage (Part C)?

The government pays more per enrollee in Part C than in traditional Medicare partly because of upcoding.

Upcoding in Medicare Advantage is estimated to cost the government approximately $10-15 billion annually.

Upcoding involves private insurers submitting inflated diagnosis codes for enrollees to receive higher risk-adjusted

84. [Lecture Topics 5-6-79] Which statement(s) correctly describe(s) how the Cost-Sharing Reduction subsidies (CSRs) work for eligible individuals on the exchanges?

CSRs increase the actuarial value of silver plans for eligible individuals, making healthcare more affordable by reducing deductibles, copayments, and coinsurance.

85. [Lecture Topic 4-25] (Exactly One Correct Answer) Which of the following best describes the three elements common to all healthcare systems?

Payers, patients, and providers

86. [Agents and Brokers-4] Which tasks are commonly performed by agents/brokers for small employers?

Creating a “curated marketplace” of options

Explaining rating rules and compliance

Benefits design guidance

Obtaining premium quotes

87. [Lecture Topic 4-60] (Exactly One Correct Answer) Which reimbursement system pays providers a fixed amount per patient per month?

Capitation

88. [Lecture Topic 4-111] (Exactly One Correct Answer) A large employer-sponsored health plan offers all enrolled members a $150 annual premium reduction if they attend a single in-person health fair hosted at the worksite each fall. The fair includes blood pressure checks, BMI screenings, and a 20-minute session with a health educator. Attendance is recorded by badge scan at the door. No follow-up is required, and there are no health targets members must meet to receive the discount. Which of the following best describes the tool and its implications for cream-skimming?

This is a participation-based wellness program, which the insurer cannot use it to cream-skim in any meaningful way because the benefit requires only attendance rather than achieving a health outcome, making it very difficult to systematically screen out less healthy enrollees.

89. [MHIU-10] (Exactly One Correct Answer) Why could a transfer scheme that reimburses CSR-induced excess costs mitigate MHIU?

It would keep those costs from being pooled into premiums paid by unsubsidized buyers.

90. [Lecture Topic 4-138] (Exactly One Correct Answer) Why is adverse selection generally worse in the individual market than in the group market?

Because individuals directly seek coverage from insurers while knowing more about their health status, whereas group coverage pools risks somewhat even though adverse selection can still occur there.

91. [Lecture Game-36] An insurance company offers a plan that includes coverage for certain high blood pressure medications. What does this scenario illustrate?

Adverse Selection

92. [Lecture Game-12] (Exactly One Correct Answer) Which of the following correctly defines charity hazard?

The tendency of individuals not to procure insurance or take other precautions because they expect to receive charity care from others

93. [Lecture Topic 4-120] (Exactly One Correct Answer) A commercial insurer building a new narrow-network plan selects which physician groups to include by analyzing prior-year claims data. The insurer contracts only with primary care groups and specialist practices whose attributed patient panels had below-average rates of hospitalization, specialist referrals, and total cost of care. Transplant centers, high-volume oncology practices, and practices with large shares of complex chronic disease patients are excluded from the network. Which of the following best describes the tool and its implications for cream-skimming?

This is selective contracting, which the insurer can use to cream-skim because by contracting only with physicians who treat lower-cost, lower-acuity patients on average, the insurer indirectly screens its enrolled population. Patients who need the excluded practices will find the plan unattractive and self-select out, improving the risk pool without the insurer ever directly screening enrollees.

94. [MHIU-9] (Exactly One Correct Answer) The paper treats Medicaid expansion as a natural experiment because:

Expansion varied across states and time and moved CSR-intensive enrollees off exchanges exogenously, shifting the risk pool.

95. [Lecture Topic 4-32] Which of the following best illustrate the principal-agent problem in healthcare? Select all that apply.

A doctor prescribes a brand-name medication when a generic alternative is available and the doctor has ties to the manufacturer

A clinic recommends additional diagnostic tests mainly because it is paid for administering them

96. [Lecture Topic 4-75] Which of the following pairings are matched correctly?

This is an example of prior authorization applied broadly, which is usually harder to use for cream-skimming because it looks more like pure cost control

97. [Lecture Topics 5-6-63] Why might private insurers participate in Medicare Part D, despite the high costs of covering elderly enrollees?

The government provides direct subsidies and reinsurance payments to private insurers

98. [RAND HIE-7] Which structural features distinguished the “individual deductible plan”?

Inpatient care was free from the outset

Outpatient care faced a high coinsurance until a small deductible was met

99. [Pharmaceutical Formularies and Rebates-8] Under a two-tier branded formulary, which mechanisms raise negotiated re bates?

The credible threat of being placed on a less preferred tier

Manufacturers paying to avoid worse disagreement outcomes

100. [Lecture Topics 5-6-82] Which of the following statement/s is/are accurate about Medicare Part A?

There are no annual limits on out-of-pocket costs.

The benefit period begins each time a Medicare beneficiary is admitted to a hospital or skilled nursing facility and ends when the patient has not receive care for 60 days.

101. [Lecture Topic 4-1] What is/are the role/s of the sponsor in the healthcare system?

Manage enrollment

Contract to negotiate risk sharing arrangements

Structure coverage

Collect and submit the contributions of insureds

102. [Lecture Game-4] (Exactly One Correct Answer) Why did private insurance premiums increase following the drop in Medicare reimbursement rates?

Hospitals cost-shifted by raising negotiated rates with private insurers to offset Medicare losses, and insurers passed these higher costs on through premium increases