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Health Care Reform:

Health Insurance & Affordable Care Act

Quiz: Do You Know Your Health Insurance Basics?

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A premium is:

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A premium is:

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A premium is a regular amount that you and/or your employer pay for your health insurance.  You might pay it once a month, once a quarter, or one time a year.  In 2012, the average yearly premium for a person with insurance through his job was $5,615, with the worker paying about $951,  and the employer paying the rest.

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A deductible is:

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A deductible is:

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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 and your insurance will cover the rest, or part of the rest.

A copay is:

A copay is:

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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.  Instead of copays, some health plans instead have coinsurance.  With it, you pay a percentage of the amount of a covered medical service allowed by your insurer. If your plan’s allowed amount is $300 for a doctor’s appointment and you’ve met your deductible, your coinsurance payment of 20% would be $60.

An out-of-pocket maximum is:

An out-of-pocket maximum is:

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Your out-of-pocket maximum is the most you have to pay each year before your insurance pays for all your care. All plans don't include what you pay in premiums toward that maximum. The Affordable Care Act limits the out-of-pocket maximums. In 2015, for one adult, it can be no more than $6,350, and for a family, it can be no more than $12,700.

Preauthorization for a test or procedure must come from your:

Preauthorization for a test or procedure must come from your:

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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:

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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 limits your choice of doctors.

An HMO limits your choice of doctors.

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  • 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.

A health insurance Marketplace is a:

A health insurance Marketplace is a:

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  • Correct Answer:

Under the Affordable Care Act, 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. 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. You can enroll in a health plan on your state's Marketplace starting Oct. 1, 2013.

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.

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  • 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, or a heart condition, or asthma. Starting with new plans issued in 2010, insurers can no longer deny coverage to children with pre-existing conditions. That protection will extend to everyone, regardless of age, beginning with new plans issued in 2014.

Preventive care includes:

Preventive care includes:

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Under the Affordable Care Act, 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 screening tests like colonoscopies, pap smears, and mammograms, as well as breastfeeding support and supplies. And there are more.  

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