Skip to content

Health Care Reform:

Health Insurance & Affordable Care Act

This content is selected and controlled by WebMD's editorial staff and is brought to you by Humana®.

Quiz: Do You Know Your Health Insurance Basics?

  1 of  
Current Score:  
Loading..Please Wait
slide image

A premium is:

slide image

A premium is:

  • Your Answer:
  • Correct Answer:

A premium is the amount that you and/or your employer pay for your health insurance, generally once a month.

slide image

A deductible is:

slide image

A deductible is:

  • Your Answer:
  • Correct Answer:

A deductible is what you must pay for your health care before your insurance pays its part.  Most plans have deductibles, which start over every January. For example, if your plan has a $1,000 deductible and you have surgery that costs $5,000, you’ll pay $1,000 before your insurer helps you cover your bills.

A copay is:

A copay is:

  • Your Answer:
  • Correct Answer:

A copay is a small, fixed amount -- often $15 or $20 -- that you pay for covered services like a prescription or a doctor’s visit. Some health plans also apply coinsurance to certain services. With it, you pay a percentage of the total cost of care. For example, if you have a 20% coinsurance, and your doctor's appointment costs $300, you'd pay $60. That's if you've met your deductible.

An out-of-pocket maximum is:

An out-of-pocket maximum is:

  • Your Answer:
  • Correct Answer:

Your out-of-pocket maximum is the most you have to pay each year toward your medical services or prescription drugs before your insurance pays for all your care. This amount does not include what you pay in premiums. The Affordable Care Act limits the out-of-pocket maximums. In 2015, for one adult, it can be no more than $6,600, and for a family, it can be no more than $13,200.

Before you get certain tests or procedures, you must have permission from your:

Before you get certain tests or procedures, you must have permission from your:

  • Your Answer:
  • Correct Answer:

If your doctor says you need a test or procedure, your health plan may have to give permission if it's to be covered by insurance. Giving that permission is called preauthorization. Your plan's overview of benefits lists what care needs to be preauthorized. If you don't get it when it's required, your health plan won't pay its part of the costs.

EOB means:

EOB means:

  • Your Answer:
  • Correct Answer:

After you’ve visited your doctor or had a procedure in a hospital, you’ll receive an explanation of benefits form telling you how much of the charges your insurance will pay. The EOB isn’t a bill itself, but it can tell you what your doctor may charge you. Look for the words “due from patient” to see how much you may owe after your insurance pays.

An HMO health plan limits your choice of doctors.

An HMO health plan limits your choice of doctors.

  • Your Answer:
  • Correct Answer:

An HMO, or health maintenance organization, has its own network of doctors, hospitals, specialists, and pharmacists that its members are required to use. You can go out of network, but if you do, you will probably have to pay 100% of the cost of your care unless it's an emergency.

A health insurance Marketplace is a:

A health insurance Marketplace is a:

  • Your Answer:
  • Correct Answer:

Each state must have a health insurance Marketplace, also called an Exchange. This web site is for people who don't have insurance from an employer or through Medicare, Medicaid, the VA, or TRICARE. On it, you can compare health plans. And you can find out whether you qualify for a subsidy, which is money from the federal government to lower your insurance costs.

Under the Affordable Care Act, you can be denied health insurance for a pre-existing condition.

Under the Affordable Care Act, you can be denied health insurance for a pre-existing condition.

  • Your Answer:
  • Correct Answer:

Before the act was passed, health insurance plans could deny coverage or limit benefits if you had a pre-existing condition like diabetes, heart disease, or asthma. Insurers can no longer refuse to cover anyone because of pre-existing conditions or charge them more for a health plan.

Preventive care includes:

Preventive care includes:

  • Your Answer:
  • Correct Answer:

Under the health care reform law, many preventive care services now must be fully covered by health insurance. That means you don't have a copay, owe  coinsurance, or have to meet a deductible first. These services include annual well-visits, screening tests like colonoscopies, pap smears, and mammograms, as well as breastfeeding support and supplies. And there are more.  

Calculating results…

Your Score:     You correctly answered   out of   questions.
Your Score:     You correctly answered   out of   questions.
results image

Best coverage: You know all there is to know about health insurance.

Basic Coverage: You could learn more about health insurance. Hit the books and try again.

Entry-level Coverage: You have a lot to learn about health insurance. Hit the books and take the quiz again.

Find out if you qualify for help paying for health insurance

Find out if you qualify for help paying for health insurance

41% of people who qualify for help paying for health insurance don't know it.* Do you?

*Commonwealth Fund, April-June 2014

close

From Our Sponsor

Content under this heading is from or created on behalf of the named sponsor. This content is not subject to the WebMD Editorial Policy and is not reviewed by the WebMD Editorial department for accuracy, objectivity or balance.

URAC: Accredited Health Web Site TRUSTe online privacy certification HONcode Seal AdChoices