Chapter 11: Planning for Health Care
Expenses Questions & Answers
Premiums - ANSWERthe monthly or annual cost of a health care plan
Patient Protection and Affordable Care Act (ACA) - ANSWERthe law passed by
Congress in 2010 to provide affordable health insurance for all U.S. citizens and reduce
the growth in health care spending
Essential health benefits - ANSWERa list of ten categories of benefits that all health
care plans sold on the health insurance exchanges must provide
1. ambulatory patient services, such as doctor's vists and outpatient services
2. emergency services
3. hospitalization
4. maternity and newborn care
5. mental health and substance disorder services, including behavioral health treatment
6. prescription drugs
7. rehabilitative services and devices
8. laboratory services
9. preventive and wellness services and chronic disease management
10. pediatric services, including oral and vision care
What happens if you don't have health insurance? - ANSWERYou must pay a penalty
tax equal to the greatest of 1% of your income or $325
Health insurance exchange (HIX) - ANSWERstate-by-state mechanism established by
the ACA through which consumers can produce a health care plan
- also known as the health insurance marketplace
Health care plan - ANSWERgeneric name for any program that pays or provides
reimbursement for health care expenditures
Group health plan - ANSWERsold collectively to an entire group of people rather than to
individuals, such as the group health care policies offered by employers
Health insurance - ANSWERprovides protection against direct medical expenses
resulting from illness and injury based on the concept of payment after an expense
occurs
- traditional health insurance plan
- fee-for-service health plan
Deductibles - ANSWERclauses in health care plans that require the participant to pay
an additional portion of health expenses annually before receiving reimbursement
Expenses Questions & Answers
Premiums - ANSWERthe monthly or annual cost of a health care plan
Patient Protection and Affordable Care Act (ACA) - ANSWERthe law passed by
Congress in 2010 to provide affordable health insurance for all U.S. citizens and reduce
the growth in health care spending
Essential health benefits - ANSWERa list of ten categories of benefits that all health
care plans sold on the health insurance exchanges must provide
1. ambulatory patient services, such as doctor's vists and outpatient services
2. emergency services
3. hospitalization
4. maternity and newborn care
5. mental health and substance disorder services, including behavioral health treatment
6. prescription drugs
7. rehabilitative services and devices
8. laboratory services
9. preventive and wellness services and chronic disease management
10. pediatric services, including oral and vision care
What happens if you don't have health insurance? - ANSWERYou must pay a penalty
tax equal to the greatest of 1% of your income or $325
Health insurance exchange (HIX) - ANSWERstate-by-state mechanism established by
the ACA through which consumers can produce a health care plan
- also known as the health insurance marketplace
Health care plan - ANSWERgeneric name for any program that pays or provides
reimbursement for health care expenditures
Group health plan - ANSWERsold collectively to an entire group of people rather than to
individuals, such as the group health care policies offered by employers
Health insurance - ANSWERprovides protection against direct medical expenses
resulting from illness and injury based on the concept of payment after an expense
occurs
- traditional health insurance plan
- fee-for-service health plan
Deductibles - ANSWERclauses in health care plans that require the participant to pay
an additional portion of health expenses annually before receiving reimbursement
