Medical Insurance Basics
What is the main purpose of medical insurance?
To help cover medical expenses and protect people from high healthcare costs.
What is a premium in medical insurance?
The monthly amount paid to keep health insurance active.
What does it mean when a doctor is in-network?
The doctor has an agreement with the insurance company to provide services at a lower cost.
What is one type of medical service that is typically covered by insurance?
Preventive care (like vaccinations and check-ups).
What is co-insurance, and how is it different from a co-pay?
Co-insurance is a percentage of costs a person pays after the deductible, while a co-pay is a fixed amount for a service.
Name two common ways people get medical insurance.
Employer-sponsored plans and Marketplace (ACA) plans.
What is the difference between a deductible and a co-pay?
A deductible is the amount you must pay before insurance starts covering costs; a co-pay is a fixed fee paid for services like doctor visits.
When picking an insurance plan, why is it important to check if your preferred doctors are covered?
Seeing an out-of-network doctor can lead to much higher costs.
Name a type of care that may not be covered under basic health insurance.
Dental, vision, or mental health services.
What happens if you don’t pay your monthly premium?
Your insurance may be canceled after a grace period.
What government programs provide health insurance to certain groups of people?
Medicare (for people 65+ and some disabled individuals) and Medicaid (for low-income individuals and families).
What does out-of-pocket maximum mean?
Out-of-pocket maximum is the most a health insurance policyholder will pay each year for covered healthcare expenses. When this limit is reached, your health plan will cover 100% of your qualified expenses.
Name two factors to consider when choosing an insurance plan.
Cost (premiums, deductibles) and coverage (what services are included).
What is an example of an unexpected medical cost people might face even with insurance?
Out-of-network charges, high deductibles, or uncovered procedures.
Why do some people choose low-premium, high-deductible plans?
They save money on monthly costs but risk paying more if they need frequent medical care.
Why is having medical insurance important for financial protection?
It prevents people from paying full price for expensive medical services, reducing the risk of financial hardship.
Name one major difference between an employer-sponsored plan and a marketplace (ACA) plan.
Employer-sponsored plans are provided through work, while Marketplace plans are purchased individually and may have government subsidies.
What steps should you take before visiting a specialist under your insurance plan?
Check if they are in-network, get a referral if needed, and confirm coverage for the visit.
What is one common mistake people make when choosing a deductible?
Choosing a high deductible without having enough savings to cover it in an emergency.
What is the purpose of an out-of-pocket maximum?
It protects people from excessive medical costs by capping what they have to pay in a year.
What is the Affordable Care Act (ACA), and how does it help people get insurance?
The ACA is a healthcare law that makes insurance more accessible by providing subsidies, expanding Medicaid, and prohibiting discrimination based on pre-existing conditions.
Why might someone choose a short-term insurance plan instead of a long-term one?
Short-term plans offer temporary coverage for people between jobs or waiting for long-term insurance to start but may have limited benefits.
Why might a high-deductible health plan (HDHP) be a better choice for some people?
It has lower monthly premiums and can be paired with a Health Savings Account (HSA) for tax-free medical expenses.
How can scam health insurance plans trick people, and what should you look out for?
Scams may offer “too good to be true” low prices but have hidden fees or little coverage; always check for official licensing and read fine print.
If your insurance doesn’t cover a service, what are two ways you can reduce costs?
Negotiate with the provider, use discount programs, or seek financial assistance.