Health Insurance in USA EXAM Questions AND Correct Answers
a tax credit can significantly lower your premium if you qualify.10 for
Obamacare marketplace plans - ✔✔
An open enrollment period is a window of opportunity during which
you can enroll in a new health care plan or drop your current
coverage. - ✔✔
Annual deductible: - ✔✔The annual deductible is amount you pay
each plan year before the insurance company starts paying its share
of the costs. If the deductible is $2,000, then you would responsible
for paying the first $2,000 in health care you receive each year, after
which the insurance company would start paying its share.
Annual out-of-pocket maximum: - ✔✔The annual out-of-pocket
maximum is the most cost-sharing you will be responsible for in a
year. It is the total of your deductible, copays, and coinsurance (but
does not include your premiums). Once you hit this limit, the
insurance company will pick up 100 percent of your covered costs for
the remainder of the plan year. Most enrollees never reach the out-
of-pocket limit but it can happen if a lot of costly treatment for a
serious accident or illness is needed. Plans with higher premiums
generally have lower out-of-pocket limits.
Before World War II, most Americans had no health insurance. The
policies that existed only covered the cost of the hospital room and
,board. After the war, the federal government instituted a wage freeze
to curb inflation, but that meant companies couldn't give raises to get
the best employees. Instead, they offered benefits, including health
insurance. - ✔✔In 1954, the Internal Revenue Service made health
insurance premiums non-taxable.6
That made an additional dollar of health insurance more valuable
than a dollar of taxable salary. The Tax Policy Center estimates that
this tax break alone increased the federal deficit by $273 billion in
2019, but politicians aren't likely to get re-elected if they suggest
removing it.
But under certain circumstances, open enrollment dates can change.
For example, in 2021, the federal government held Marketplace open
enrollment from mid-February through mid-May - ✔✔
Canceling a marketplace plan is as easy as logging into your
marketplace account and selecting "Start a new application or update
an existing one." To set a future cancellation date for some people on
your plan, call the marketplace call center at (800) 318-2596.2 - ✔✔
Changes made during open enrollment take effect on Jan. 1 of the
following year. For instance, if you change your health care plan on
Nov. 15 during open enrollment, your current coverage will continue
through Dec. 31 and the new plan will kick in the next day.2 - ✔✔
, Coinsurance: - ✔✔Coinsurance is a percentage of the cost of your
medical care. For an MRI that costs $1,000, you might pay 20 percent
($200). Your insurance company will pay the other 80 percent ($800).
Plans with higher premiums typically have less coinsurance.
Copayment (or 'Copay'): - ✔✔The copay is a fixed, upfront amount
you pay each time you receive care when that care is subject to a
copay. For example, a copay of $30 might be applicable for a doctor
visit, after which the insurance company picks up the rest. Plans with
higher premiums generally have lower copays and vice versa. Plans
that do not have copays typically use other methods of cost sharing.
Exclusive provider organizations (EPO) - ✔✔Combination of HMO and
PPO plans
Restrictive in the number and type of providers they have and
consequently are more like HMO's and will not pay if out of network
providers are used
With an EPO, the plan will only cover costs if you seek the services of
doctors, hospitals, and services within the defined network, except
when you need emergency care.
Federal and state governments work together to provide Medicaid, -
✔✔Eligibility is base on modified adjusted gross income
a tax credit can significantly lower your premium if you qualify.10 for
Obamacare marketplace plans - ✔✔
An open enrollment period is a window of opportunity during which
you can enroll in a new health care plan or drop your current
coverage. - ✔✔
Annual deductible: - ✔✔The annual deductible is amount you pay
each plan year before the insurance company starts paying its share
of the costs. If the deductible is $2,000, then you would responsible
for paying the first $2,000 in health care you receive each year, after
which the insurance company would start paying its share.
Annual out-of-pocket maximum: - ✔✔The annual out-of-pocket
maximum is the most cost-sharing you will be responsible for in a
year. It is the total of your deductible, copays, and coinsurance (but
does not include your premiums). Once you hit this limit, the
insurance company will pick up 100 percent of your covered costs for
the remainder of the plan year. Most enrollees never reach the out-
of-pocket limit but it can happen if a lot of costly treatment for a
serious accident or illness is needed. Plans with higher premiums
generally have lower out-of-pocket limits.
Before World War II, most Americans had no health insurance. The
policies that existed only covered the cost of the hospital room and
,board. After the war, the federal government instituted a wage freeze
to curb inflation, but that meant companies couldn't give raises to get
the best employees. Instead, they offered benefits, including health
insurance. - ✔✔In 1954, the Internal Revenue Service made health
insurance premiums non-taxable.6
That made an additional dollar of health insurance more valuable
than a dollar of taxable salary. The Tax Policy Center estimates that
this tax break alone increased the federal deficit by $273 billion in
2019, but politicians aren't likely to get re-elected if they suggest
removing it.
But under certain circumstances, open enrollment dates can change.
For example, in 2021, the federal government held Marketplace open
enrollment from mid-February through mid-May - ✔✔
Canceling a marketplace plan is as easy as logging into your
marketplace account and selecting "Start a new application or update
an existing one." To set a future cancellation date for some people on
your plan, call the marketplace call center at (800) 318-2596.2 - ✔✔
Changes made during open enrollment take effect on Jan. 1 of the
following year. For instance, if you change your health care plan on
Nov. 15 during open enrollment, your current coverage will continue
through Dec. 31 and the new plan will kick in the next day.2 - ✔✔
, Coinsurance: - ✔✔Coinsurance is a percentage of the cost of your
medical care. For an MRI that costs $1,000, you might pay 20 percent
($200). Your insurance company will pay the other 80 percent ($800).
Plans with higher premiums typically have less coinsurance.
Copayment (or 'Copay'): - ✔✔The copay is a fixed, upfront amount
you pay each time you receive care when that care is subject to a
copay. For example, a copay of $30 might be applicable for a doctor
visit, after which the insurance company picks up the rest. Plans with
higher premiums generally have lower copays and vice versa. Plans
that do not have copays typically use other methods of cost sharing.
Exclusive provider organizations (EPO) - ✔✔Combination of HMO and
PPO plans
Restrictive in the number and type of providers they have and
consequently are more like HMO's and will not pay if out of network
providers are used
With an EPO, the plan will only cover costs if you seek the services of
doctors, hospitals, and services within the defined network, except
when you need emergency care.
Federal and state governments work together to provide Medicaid, -
✔✔Eligibility is base on modified adjusted gross income
