By Christina Joseph
Preventive care. Deductibles. Flexible spending accounts. Even if you’re fit as a fiddle, knowing your health care terms can save you money. So how much do you know about health care? Take our quiz and find out.
1. A copay is…
A. Someone who agrees to help you pay your medical bills.
B. The maximum doctor visits you’re allowed each year.
C. A set dollar amount you pay for certain medical visits and services.
C. A copay is a set dollar amount you pay for certain medical visits and services.
You may have a set copay for generic prescription drugs, lab tests and visits to specialists.
Find out more about copays and other insurance payment terms.
2. Vision insurance…
A. Vision insurance helps cover prescription lenses (eyeglass lenses or contact lenses) and frames. Some plans may also cover or provide discounts for routine vision exams.
B. Sends you new prescription glasses every month by mail.
C. Primarily covers treatment for eye diseases, such as glaucoma and cataracts.
Routine vision exams as well as treatment for eye diseases, such as glaucoma and cataracts, are usually covered by your medical plan. Vision care is often offered as a separate insurance plan.
3. HMO stands for…
A. Holistic Medical Organization, a clinic where you can receive alternative therapies.
B. Health Maintenance Organization, a health plan that generally requires you to get your care from providers who are in the HMO network. You may also need to select a primary care physician and obtain a referral before you see a specialist.
C. Health Management Option, a savings account that you can only use for health care costs
HMO plans often require you to designate a primary care physician who will provide a referral if you need a specialist.
Learn more about HMOs and other types of health plans.
4. An annual flu shot is recommended for…
A. Pregnant women, adults over 65 and anyone with a compromised immune system.
B. Adults in good health.
C. Both A and B.
C. Both A and B. An annual flu shot is recommended for everyone, including pregnant women, adults over 65, anyone with a compromised immune system, children over 6 months and adults in good health.
The flu hospitalizes 200,000 Americans annually. Many health insurers, including Aetna, offer the flu shot at no cost to members. Call your plan provider or primary care physician to learn more.
5. Open enrollment refers to…
A. The time period when you can enroll in a health plan.
B. The right to enroll in a health care plan whenever you want.
C. A health plan that allows you to go to any doctor you choose.
A. Open enrollment refers to the time period when you can enroll in a health plan.
Private employers often have enrollment periods that last from two to four weeks.
6. You should visit an urgent care center…
A. When you need a routine eye exam and can’t get an appointment with your regular doctor.
B. If you’re experiencing non-life-threatening symptoms, such as a sprain, a cut that requires stitches or a rash.
C. Only for serious symptoms like sudden chest pain.
B. You should visit an urgent care center if you’re experiencing non-life threatening symptoms, such as a sprain, a cut that requires stitches or a rash.
Most insurance plans treat visits to urgent care centers like a trip to a specialist, charging a flat fee for treatment. Urgent care can offer prompt medical care after hours and on weekends.
Find out more about when you should use urgent care versus visit the emergency room.
7. A referral is…
A. A recommendation from a friend for a particular doctor.
B. Permission given by your employer’s benefits department to sign up for a health plan.
C. A written or electronic record from your primary care doctor allowing you to visit a specialist or health care facility.
C. A referral is a written or electronic record from your primary care doctor allowing you to visit a specialist or health care facility.
HMOs and EPOs often require referrals before you can see a specialist.
8. An insurance premium is…
A. A perk you receive through your health insurance, such as a gym reimbursement or 24/7 nurse hotline.
B. The annual window of time when you can make changes to your insurance.
C. The monthly cost of insurance coverage.
C. An insurance premium is the monthly cost of insurance coverage.
You will pay one premium to cover yourself, your spouse and any dependents. High-deductible health plans often have the lowest premiums.
Find out more about premiums and other insurance payment terms.
9. A high-deductible health plan (HDHP) features…
A. The highest rating given by insurance regulators.
B. Lower premiums but higher upfront out of pocket costs when you use the plan.
C. Higher premiums but lower upfront out of pocket costs when you use the plan.
B. Lower premiums but higher upfront out of pocket costs when you use the plan.
An HDHP might be right for you if you’re relatively healthy and don’t expect to use many health care services over the next year. However, if you do experience a health problem, you’ll pay out-of-pocket for care and may not meet your deductible until late in the year, if at all.
10. You can change your health insurance plan…
A. Anytime you want.
B. During open enrollment or after a qualifying life event, such as a job change, marriage or new baby.
C. If your doctor stops taking your insurance plan.
B. You can change your health insurance plan during open enrollment or after a qualifying life event, such as job change, marriage or new baby.
Qualifying life events trigger a “special enrollment period” that typically lasts 30 to 60 days, during which you can select a new plan or add a dependent.
11. Your health insurance plan can offer surprising perks, but not…
A. Reimbursements for fitness memberships and yoga classes.
B. Free groceries delivered to your home.
C. Online finance tools to help you budget for medical services.
B. Your health insurance plan can offer surprising perks, but not free groceries delivered to your home.
Perks and reimbursements vary depending on your plan. Check with your benefits manager for details.
12. A deductible is...
A. The amount you pay for covered health care expenses before insurance kicks in.
B. The money deducted from your paycheck to pay for your insurance plan.
C. The money your health care plan pays you when you have an accident.
A. The amount you pay for covered health care expenses before insurance kicks in.
Many covered health services count toward your deductible. Some exceptions are free preventive care visits and some disease management programs.
Find out more about deductibles and other insurance payment terms.
13. Coinsurance is…
A. A secondary insurance plan.
B. Additional persons added to your insurance plan, such as a spouse or child.
C. The percentage of covered health care expenses you pay after you meet your deductible..
C..Coinsurance is the percentage of covered health care expenses you pay after you meet your deductible.
Coinsurance is a form of cost-sharing between you and the insurance company. It can apply to office visits, procedures and prescriptions. In general, plans with lower monthly premiums have higher coinsurance.
Find out more about coinsurance and other insurance payment terms.
14. The main difference between a health savings account (HSA) and a flexible spending account (FSA) is…
A. HSAs allow you to roll over funds year after year, while the money left in an FSA at year’s end is generally lost.
B. HSAs have annual contribution limits, but FSAs have no limits.
C. FSA holders can’t spend more than what’s already been deducted from their paycheck.
A. The main difference between a health savings account (HSA) and a flexible spending account (FSA) is that HSAs allow you to roll over funds year after year, while the money left in an FSA at year’s end is generally lost.
Both HSAs and FSAs allow you to contribute pre-tax dollars to cover future medical expenses and have annual contribution limits. HSAs are often paired with high-deductible health plans (HDHP).
15. An out-of-pocket maximum is…
A. The highest dollar amount you may pay out-of-pocket for covered medical services, usually per year.
B. The total of all the medical costs you’ve paid during your lifetime.
C. The amount of money you’re charged for a visit to the emergency room.
A. An out-of-pocket maximum is the highest dollar amount you may pay for covered medical services, usually per year.
Your insurance plan sets a dollar amount for your out-of-pocket maximum, which includes your deductible, copayments and coinsurance. Once you reach it, your health plan pays 100% of the cost of covered benefits.
How did you do?
13-15 correct: Congrats, you’re a health insurance rock star. When open enrollment comes around, you’re the one friends go to for advice.
10-12 correct: Great job! You have a good handle on how health insurance works. And you have no trouble navigating your choices to get the best value.
7-9 correct: You know the basics and then some. Soon you’ll feel more confident about finding the right plan.
4-6 correct: You’re getting there. Brush up on some health care topics , then try the quiz again.
1-3 correct: You’re starting to learn key health insurance terms. Luckily, you’re in the right place to learn a whole lot more.
Christina Joseph Robinson is a veteran editor and writer from New Jersey who still loves to read the old-fashioned newspaper. She’s raising two fruit-and-veggie loving daughters to balance all the treats Grandma sends their way. Christina’s health goal is to resume her workout routine after being sidelined by injuries.
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