Health Insurance Practice Questions and Answers Latest Version with Certified Solutions

Health Insurance Practice Questions and Answers Latest Version with Certified Solutions Who pays the premium in a health insurance plan? The policyholder or the employer, depending on the plan. What does a deductible mean in a health insurance policy? The amount the insured must pay out of pocket before the insurance company starts paying. What is a copayment in health insurance? A fixed amount the insured pays for a covered healthcare service, usually at the time of service. What does coinsurance refer to in health insurance? The percentage of costs the insured pays after meeting the deductible. Why is it important to check if a healthcare provider is in-network? 2 Because in-network providers usually cost less and the insurance covers more of the expense. What is an out-of-pocket maximum? The most a person has to pay during a policy period before the insurance pays 100% of covered services. How does Medicaid differ from Medicare? Medicaid is for low-income individuals and families, while Medicare is primarily for people aged 65 and older. What type of health insurance plan requires a referral to see a specialist? Health Maintenance Organization (HMO). What does the term "pre-existing condition" mean in health insurance? A health problem that existed before the start of the health insurance coverage. Why do some health insurance plans have a network of providers? 3 To control costs and ensure coordinated care. What is the purpose of an Explanation of Benefits (EOB)? To show what medical services were billed, what the insurance covered, and what the patient owes. What is the difference between a premium and a deductible? Premium is the regular payment to maintain coverage; deductible is the amount paid out of pocket before coverage starts. Why might someone choose a high deductible health plan (HDHP)? Because premiums are usually lower and it can be paired with a Health Savings Account (HSA). What is a formulary in health insurance? A list of prescription drugs covered by a health insurance plan. What is the role of the Affordable Care Act (ACA) in health insurance? 4 It expanded access to insurance and established standards like coverage for pre-existing conditions. What is the meaning of "coverage limit" in a health insurance policy? The maximum amount the insurance will pay for covered services. Why is it important to review your health insurance policy every year? Because benefits, costs, and networks