Filling the need for trusted information on national health issues…

What is a health insurance premium? Can you describe what an annual health insurance deductible is? If you answered, “no,” you’re not alone. The language of health insurance can be complex and confusing, particularly for many long-time uninsured people enrolling in the new insurance marketplaces set up under the Affordable Care Act.

Take this 10-question quiz and learn how health insurance literate you are compared to a nationally representative survey of U.S. adults who were asked the same questions.

Get Started

1

Which of the following is the best definition of the term “health insurance premium?”

The premium is the monthly fee all enrollees pay in order to have health insurance coverage.

76% of Americans answered this question correctly.

2

Is a health insurance premium something you must pay every month, regardless of whether you use health care services, or do you only have to pay your health insurance premium during months when you use health care services?

You must pay insurance premiums every month.

79% of Americans answered this question correctly.

3

Which of the following is the best definition of the term “annual health insurance deductible?"

A deductible is one type of “cost-sharing” feature often included in a health insurance policy.

72% of Americans answered this question correctly.

4

Suppose that under your health insurance policy, hospital expenses are subject to a $1,000 deductible and $250 per day copay. You get sick and are hospitalized for 4 days, and the bill (after insurance discounts are applied) comes to $6,000. How much of that hospital bill will you have to pay yourself?

You pay the first $1,000 of the discounted (or allowed) charge because of the deductible, plus 4 copays of $250 per day, or another $1,000. That comes to $1,000 + $1,000, for a total of $2,000 that you pay out of pocket.

51% of Americans answered this question correctly.

5

Which of the following best describes the “annual out-of-pocket limit” under a health insurance policy?

Health plans sold through the Marketplace and most employer health plans must cap the amount you are required to pay each year in deductibles, copays, and coinsurance for covered services received in network.

67% of Americans answered this question correctly.

6

Which of the following best describes a “health insurance formulary?"

The list of what drugs your health plan will cover, and what cost-sharing you owe for different drugs, is called the drug formulary.

33% of Americans answered this question correctly.

7

Which of the following best describes a health plan “provider network?"

Most health plans establish a network of providers and provide the highest level of coverage when you get care from them.

76% of Americans answered this question correctly.

8

True or false: If you receive inpatient care at a hospital that participates in your health plan’s provider network, all the doctors who care for you while you’re in the hospital will also be in network.

Often doctors who work in a hospital don’t work for the hospital.

41% of Americans answered this question correctly.

9

Suppose your health plan covers lab tests in full if you go to an in-network lab, but only pays 60% of allowed charges if you go out of network. You forget to check and go get your blood test at a lab that turns out to be out of network. The lab bills you $100 for the blood test. Your health insurance allows only a $20 charge for that test. How much would you have to pay out of pocket for that lab test?

Your health plan will pay 60% of the $20 allowed charge, or $12. Because the lab is not in network, it is not required to accept the health insurance’s discounted price, which is also called the allowed charge. The lab can bill you for the balance, which is $88.

16% of Americans answered this question correctly.

10

True or false? If your health insurance or health plan refuses to pay for a service that you think is covered and your doctor says you need, you can appeal the denial and possibly get the insurance company to pay the claim.

Consumers have the right to formally appeal if they get into a dispute with the health plan about whether services are medically necessary and appropriate and should be covered.

68% of Americans answered this question correctly.

of

Health Insurance Quiz

You Answered out of 10 Questions Correctly.

How Others Scored

Number Correct Percentage Earning This Score
0 8%
1 5%
2 5%
3 4%
4 6%
5 10%
6 10%
7 18%
8 18%
9 12%
10 4%

Question

Correct Response

1

Which of the following is the best definition of the term “health insurance premium?”

The premium is the monthly fee all enrollees pay in order to have health insurance coverage.

The premium is the monthly fee all enrollees pay in order to have health insurance coverage.

76% of Americans answered this question correctly.

2

Is a health insurance premium something you must pay every month, regardless of whether you use health care services, or do you only have to pay your health insurance premium during months when you use health care services?

You must pay insurance premiums every month.

You must pay insurance premiums every month.  Insurance is a way people in a community cover health costs collectively.  In months when you are healthy and don’t use health care services, your premium dollars are used to pay health care costs of other people covered under the same plan.  When you need health care, other people’s premiums will help pay for your medical costs.

79% of Americans answered this question correctly.

3

Which of the following is the best definition of the term “annual health insurance deductible?"

A deductible is one type of “cost-sharing” feature often included in a health insurance policy.

A deductible is one type of “cost-sharing” feature often included in a health insurance policy.  It reflects an initial amount of covered health care expenses that you must pay out of pocket.  Your health plan will then begin to reimburse covered health care expenses beyond that deductible amount.

72% of Americans answered this question correctly.

4

Suppose that under your health insurance policy, hospital expenses are subject to a $1,000 deductible and $250 per day copay. You get sick and are hospitalized for 4 days, and the bill (after insurance discounts are applied) comes to $6,000. How much of that hospital bill will you have to pay yourself?

You pay the first $1,000 of the discounted (or allowed) charge because of the deductible, plus 4 copays of $250 per day, or another $1,000. That comes to $1,000 + $1,000, for a total of $2,000 that you pay out of pocket.

You pay the first $1,000 of the discounted (or allowed) charge because of the deductible, plus 4 copays of $250 per day, or another $1,000.  That comes to $1,000 + $1,000, for a total of $2,000 that you pay out of pocket.

51% of Americans answered this question correctly.

5

Which of the following best describes the “annual out-of-pocket limit” under a health insurance policy?

Health plans sold through the Marketplace and most employer health plans must cap the amount you are required to pay each year in deductibles, copays, and coinsurance for covered services received in network.

Health plans sold through the Marketplace and most employer health plans must cap the amount you are required to pay each year in deductibles, copays, and coinsurance for covered services received in network.  The maximum annual out of pocket limit for 2015 plans is $6,450 for single coverage and $12,900 for family policies.

67% of Americans answered this question correctly.

6

Which of the following best describes a “health insurance formulary?"

The list of what drugs your health plan will cover, and what cost-sharing you owe for different drugs, is called the drug formulary.

The list of what drugs your health plan will cover, and what cost-sharing you owe for different drugs, is called the drug formulary.  Health plans are required to make their drug formularies available to consumers and typically post a link to the formulary on the plan website.

33% of Americans answered this question correctly.

7

Which of the following best describes a health plan “provider network?"

Most health plans establish a network of providers and provide the highest level of coverage when you get care from them.

Most health plans establish a network of providers and provide the highest level of coverage when you get care from them.  If you go out of network for care, you will probably have to pay more out of pocket, or the services might not be covered by your insurance at all.

76% of Americans answered this question correctly.

8

True or false: If you receive inpatient care at a hospital that participates in your health plan’s provider network, all the doctors who care for you while you’re in the hospital will also be in network.

Often doctors who work in a hospital don’t work for the hospital.

False. Often doctors who work in a hospital don’t work for the hospital.  It is common for doctors to bill you separately from the hospital, and they may or may not participate in the same health plan networks as the hospital.

41% of Americans answered this question correctly.

9

Suppose your health plan covers lab tests in full if you go to an in-network lab, but only pays 60% of allowed charges if you go out of network. You forget to check and go get your blood test at a lab that turns out to be out of network. The lab bills you $100 for the blood test. Your health insurance allows only a $20 charge for that test. How much would you have to pay out of pocket for that lab test?

Your health plan will pay 60% of the $20 allowed charge, or $12. Because the lab is not in network, it is not required to accept the health insurance’s discounted price, which is also called the allowed charge. The lab can bill you for the balance, which is $88.

Your health plan will pay 60% of the $20 allowed charge, or $12. Because the lab is not in network, it is not required to accept the health insurance’s discounted price, which is also called the allowed charge. The lab can bill you for the balance, which is $88.

16% of Americans answered this question correctly.

10

True or false? If your health insurance or health plan refuses to pay for a service that you think is covered and your doctor says you need, you can appeal the denial and possibly get the insurance company to pay the claim.

Consumers have the right to formally appeal if they get into a dispute with the health plan about whether services are medically necessary and appropriate and should be covered.

Consumers have the right to formally appeal if they get into a dispute with the health plan about whether services are medically necessary and appropriate and should be covered. Many states have Consumer Assistance Programs that will help consumers file appeals.  Health plans must provide a written explanation when they deny a claim; this must include information about how to appeal as well as contact information for the Consumer Assistance Program in your state.

68% of Americans answered this question correctly.

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/KaiserFamFound

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.