Insurance Basics
This is the monthly amount you pay to have insurance.
What is a premium?
This plan usually requires referrals to see specialists.
What is an HMO?
You go to an in-network doctor for a checkup. You pay a $25 fee. What is this called?
What is a copay?
This doctor is your main healthcare provider.
What is a primary care physician (PCP)?
This is the billing problem when you visit an out-of-network provider at an in-network hospital.
What is surprise billing?
This is the amount you pay before insurance starts paying.
What is a deductible?
This plan allows more flexibility but usually costs more.
What is a PPO?
You haven't met your deductible yet and receive a $600 bill. Who pays?
You do.
Seeing doctors within your plan's approved list saves you money. What is this called?
Marketplace subsidies are based on these two main factors.
What is income and household size?
This is a fixed amount you pay for a doctor visit.
What is a copay?
This insurance is offered through your job.
What is employer-sponsored insurance?
You go to an out-of-network hospital. What might happen?
Higher costs/insurance may not fully cover it.
This free yearly visit is covered by most plans.
What is a preventive visit/annual physical?
This federal law protects patients from many surprise medical bills.
What is the No Surprises Act?
This is the percentage of costs you pay after meeting your deductible.
What is coinsurance?
This government insurance is for people 65+.
What is Medicare?
You met your out-of-pocket maximum. What happens next?
Insurance covers 100% of covered services.
You should always check this before scheduling a specialist.
Whether they are in-network/if you need a referral.
This is when people use more healthcare because they're insured.
What is moral hazard?
This is the most you'll pay in a year before insurance covers 100%.
What is an out-of-pocket maximum?
This government program helps low-income individuals.
What is Medicaid?
You don't enroll during open enrollment and have no qualifying event. What happens?
You must wait until the next enrollment period.
You should always review this document to understand your coverage.
What is the Summary of Benefits and Coverage (SBC)?
Plan details include a $1,500 deductible, 20% co-insurance, and $5,000 out-of-pocket maximum. You incur a $4,000 hospital bill, so you end up paying this much.
What is $2,000?