How well do you know the ins and outs of your healthcare?

How well do you know the ins and outs of your health care?

When it comes to the details of your health insurance, there are a lot of factors to consider: deductible, coinsurance, premium, out-of-pocket maximum, copay. Understanding what everything means will give you a better grasp of just how your specific plan works. Not sure what you do and don’t know? Start by taking this quiz, then arm yourself with the information and tools you need to get the most out of your plan.

1

The word premium can have many meanings. What does it mean in terms of health insurance?

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Nice try! Health insurance premiums are actually the amount you pay every month to an insurance company for health coverage. Think of it like a gym membership – it’s what you pay to be a member and can vary based on what’s included and covered.

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You got it right!

That’s right! Health insurance premiums are typically paid every month to an insurance company for health coverage. Think of it like a gym membership – it’s what you pay to be a member and can vary based on what’s included and covered.

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2

What does a deductible payment cover?

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Close! Throughout a calendar year, the fees you acquire for health services are added towards reaching your deductible total. Once the deductible is reached, the health insurance company will pay for the services needed. For example, you start with a deductible of $2,000 each year. After a few visits to the doctor and medical tests, you have paid $500 towards your deductible of $2,000 in August. In September, you end up needing knee surgery, which costs $10,000. Rather than paying the full amount, you are responsible for paying your remaining deductible of $1,500, then the insurer covers the rest or a portion (if you have coinsurance) until next year when it starts all over again.

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You got it right!

That’s right! The fees for health services that you pay throughout the year go toward your annual deductible. Once you’ve met your deductible, you share the cost with your plan by paying coinsurance and copays up until total benefit maximum.

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3

While seeing your doctor, you are asked for a copay. What does this mean?

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Nice try! When you visit your doctor, the amount requested at the visit is a set amount designated by your plan. This amount typically ranges from $25-$50 for a scheduled doctor visit.

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You got it right!

That’s right! A copay for a scheduled doctor visit typically ranges from $25-$50 based on the type of plan you have and is paid for during the time of the visit, rather than billed later.

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4

Ouch! You sprained your ankle on Saturday and it still hurts. Where should you go first for medical care?

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Not quite! Urgent care centers may be a great economical, convenient option when you’re experiencing a non-life-threatening medical situation and can’t get into see your regular doctor. Remember, in the case of an emergency, dial 9-1-1 or visit your local ER for immediate assistance.

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You got it right!

That’s right! Urgent care centers may be a great economical, convenient option when you’re experiencing a non-life-threatening medical situation and can’t get into see your regular doctor. If it is an emergency, either dial 9-1-1 or visit your local ER.

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5

You see the letters “EOB” on mail from your health insurance after a doctor visit. What does EOB mean?

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Nice try! An EOB is your Explanation of Benefits, or your statement that shows what services your medical care insurance pays for, services not payable by insurance and why, and any charges you may owe for services received.

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You got it right!

That’s right! Your Explanation of Benefits is a great way to simply see what services your medical care insurance pays for, services not payable by insurance and why, and any charges you may owe for services received.

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6

Which of the below has the potential to provide tax savings on health care expenses now and into retirement?

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Almost! A health savings account (HSA) is a useful tool to prepare for current and future health care expenses.  HSAs work with qualified high deductible PPO and HMO health plans.  You can decide how much to put in the account every year (up to $3,400 for an individual, $6,740 for a family in 2017) and use to pay for IRS defined qualified medical expenses.  Two things to remember, your funds roll over year-over-year without limit and your funds are put in tax free, grow tax free and can be withdrawn tax free for medical expenses in the present and throughout retirement.

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You got it right!

That’s right! A health savings account (HSA) is a useful tool to prepare for current and future health care expenses.  HSAs work with qualified high deductible PPO and HMO health plans.  You can decide how much to put in the account every year (up to $3,400 for an individual, $6,740 for a family in 2017) and use to pay for IRS defined qualified medical expenses.  Two things to remember, your funds roll over year-over-year without limit and your funds are put in tax free, grow tax free and can be withdrawn tax free for medical expenses in the present and throughout retirement.

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7

You are searching for a new doctor but want to make sure they are in your plan’s network. Where should you look?

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Nice try! Although family and social media communities are great places to start for recommendations, the best place to identify if your current or new doctor is covered under your plan is through a health insurance website or mobile app, like bcbsm.com. Utilizing tools like Find a Doctor can drastically help you zero in on the best doctor to fit you and your family’s needs. You should always reach out to the doctor directly to see if they are covered, as well.

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You got it right!

That’s right! Health insurance websites or mobile apps, like bcbsm.com, are the best places to confirm if your current or new doctor is covered under your plan. Family, friends and your social communities are excellent resources for recommendations, but utilizing tools like Find A Doctor will really help you zero in on the best doctor to fit you and your family’s needs. You should always reach out to the doctor directly to see if they are covered, as well.

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8

Preventive care services like mammograms and colonoscopy screenings are covered at 100%.

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Very close! Preventive screenings are covered 100%. You won’t have to worry about a copay, coinsurance or your deductible, as long as you see an in-network doctor and your visit is just about preventive care. Always confirm which services are covered as a preventive care benefit on bcbsm.com. Many services may seem “preventive” but are not, and thus not 100% covered.

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You got it right!

That’s right! Preventive screenings are covered 100%. You won’t have to worry about a copay, coinsurance or your deductible, as long as you see an in-network doctor and your visit is just about preventive care. Always confirm which services are covered as a preventive care benefit on bcbsm.com. Many services may seem “preventive” but are not, and thus not 100% covered.

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9

The generic drugs your pharmacy gives you work just as well as the name brand ones.

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Nice try! Brand name drugs are usually what people think of when they have a health issue because these are seen in TV and magazine ads. However, generic drugs are less expensive but are just as effective. Generic drugs are thoroughly researched and must be proven to be just as safe as brand-name drugs and approved by the FDA in order to hit the market.

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You got it right!

That’s right! Generics are thoroughly researched and proven to be just as safe and effective as brand-name drugs. They are also approved by the FDA before hitting the market.

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10

Generally, out-of-network doctors will cost you less than when you visit a doctor in your network.

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Nice try! Selecting an in-network vs. out-of-network doctor can drastically affect how much you pay for your health care services. Your network is determined by your plan, and if you select care outside of your network, you could end up paying a larger percentage of the cost or the total cost.

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You got it right!

That’s right! Your network depends on your plan and picking an in-network doctor means you could receive care at lower prices. But if you go out of your network, it can become a lot more expensive – you typically have to pay a larger percentage of the cost or total cost.

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Nice Work! You got right. Nice go! You got right. Let's learn more. Your knowledge is helping make health care better and more cost-friendly for every Michigander. For more information, view the videos, links and blog posts below to learn how to get the most out of your membership.