Insurance Basics
What is the monthly amount you pay to keep your health insurance active
Premium
Which usually requires you to stay in-network and get referrals to see specialists: HMO or PPO?
HMO
What is California's Health Insurance Marketplace called?
Covered California
What is California's Medicaid program called
Medi-Cal
What is the amount you pay yourself before your insurance begins paying for most covered services?
Deductible
Which generally offers more flexibility and allows both in-network and out-of-network care?
PPO
What are the Covered California open enrollment dates presented in training?
November 1- January 15th
Chip is generally intended for uninsured children under what age?
Under 19
Which Medicare part is known as Hospital Insurance
Part A
You already met your deductible. Your plan has 20% coinsurance on a 500 dollar covered service. How much do u pay?
$100
What is the name for the list of prescription drugs an insurance plan covers?
Formulary
Someone buys health insurance directly from an insurance company instead of through the Marketplace. What financial assistance are they giving up?
Marketplace subsidies/finicial assitance
Name three types of healthcare services that CHIP may cover.
Any three: routine checkups, immunizations, doctor visits, prescriptions, dental/vision care, hospital care, lab/X-ray services, or emergency services
Which Medicare part primarily covers medical services such as doctor services and preventive care?
Part B
What is the difference between a copay and coinsurance?
A copay is a fixed dollar amount; coinsurance is a percentage of the cost.
A patient receives emergency care at an out-of-network hospital and is worried they’ll be charged the higher out-of-network rate. What federal law protects them by generally limiting their cost to the normal in-network amount?
The No Surprise Act
What enrollment option may allow someone to sign up outside normal open enrollment after certain life events? List certain life events...
Special Enrollment Period
True or False: A parent's citizenship or immigration status automatically determines whether their child can qualify for CHIP.
False - the child's citizenship or qualifying immigration status is considered.
Which Medicare part consists of Medicare Advantage plans offered through private insurance companies?
Part C
Your doctor charges $200, but your insurance company says the allowed amount is $150. The provider tries to charge you the remaining $50. What is this called?
Balance Billing
Under the prescription drug tier system from training, which type of medication would generally have the lowest copay?
Tier 1/ Generic Medication
What type of health plan has very low premiums, a very high deductible, and is generally limited to people under 30 or those who qualify for certain exemptions?
A Catastrophic Health Plan
A child appears eligible for CHIP, but their full application has not finished processing. A qualified organization gives them temporary coverage in the meantime. What is this called?
Presuptive Eligibility
Someone already has Medicare Part A. Can they also receive Premium Tax Credits or Cost Sharing Reductions for a Marketplace plan according to the training?
No - having Medicare Part A makes you ineligible for PTC and CSR