Surprise Quiz

Time for a surprise quiz! Give yourself 10 points for each correct answer. Answers at the end – no cheating!

1: Define “deductible”.

2: If your plan covers office visits BEFORE you satisfy the deductible, will you also “get credit” on the deductible for that office visit? Yes or No

3: Medicare pays for what percentage of all nursing home stays?

A: 98%

B: 48 %

C: 23%

D: 2%

4. COBRA is an acronym for what? Name 4 instances when this law allows you to continue your health insurance benefits.

5. If you work past your 65^th birthday, for a company with more than 20 employees, can you keep your group health insurance, and if so, how does that relate to Medicare?

6. What does H.M.O. stand for?

7: True or False: Medicare pays for a limited dollar amount of prescriptions each year.

8: The term co-insurance refers to what?

9: The term co-pay refers to what?

10: What does P.P.O. stand for? How is it different from an HMO?

Extra Credit: 50 points!

Think of your own health insurance plan, and answer the following:

What is your deductible?

Do you have a co-pay at the doctor’s office? If so, what is it?

Does your plan use a network?

If it uses a network, do you have out of network benefits?

How are prescriptions covered – (do you have a co-pay at the pharmacy or are they covered at a certain percentage after the deductible is satisfied. What co-pay , or what percentage?)

Optional Extra credit for those over the age of 40:

Give yourself 10 points if you have a long term care insurance policy.

Give yourself 3 points if you have started to investigate this coverage.

Subtract 20 points if you have no idea what long term care insurance is.

ANSWER KEY:

1. A “deductible” is an amount of money that you must spend out of your pocket before the insurance plan will start to pay.

2. No. This question comes up frequently. If you do not need to satisfy the deductible for certain benefits to be payable, you do not “get credit” for it. You can’t have it both ways.

3. D – Medicare pays for less than 2% of all nursing home stays!! That means that 98% of all nursing home stays are NOT covered by Medicare. If you need care in a nursing home, will you be part of the 2% or 98%?

4. COBRA stands for Consolidated Omnibus Budget Reconciliation Act. It allows you to continue benefits when they would have otherwise ended due to the termination of employment (either you quit or were terminated), you became divorced from the insured spouse, the insured spouse passed away, or your college age student “aged-out”.

5. Yes, If you work past age 65 for a company with more than 20 employees, you can continue your group health insurance. It will be primary and Medicare secondary. Many people elect to do this for the prescription benefit alone. Others prefer the reduced premium of a Medicare supplement if they do not have any, or many, prescriptions and were responsible for a portion of the premium. Everyone’s situation is different, be sure to get good advice for your particular situation.

6. H.M.O. stands for Health Maintenance Organization

7. False. Medicare does NOT cover prescriptions. Only exceptions are injectable chemotherapy drugs.

8. Co-Insurance refers to what you will pay after insurance pays. For example, if you have a 70/30 plan, the 30% is your co-insurance.

9. Co-pay refers to what you pay (as opposed to what the insurance company pays) but co-pay is a term usually used for the small amount of money you pay at the doctor’s office. Example, $20 co-pay – or for prescriptions, you may have a $15 co-pay at the pharmacy.

10. PPO Stands for Preferred Provider Organization. It differs from an HMO in many ways, but the main difference is that you do not need to choose a primary care physician and get referrals to see a specialist as you do with an HMO.

SCORING:

Between 150 points and 90 points:

You are very insurance savvy! Tell your spouse (or a friend) that you scored very high and deserve a dinner out!

Between 89 - 50

Average. Make sure you have your health insurance card in your wallet and hope you don’t get the front desk trainee when you go to the doctor’s office or hospital!

Less than 50 points: Give the test to your spouse to take. Obviously, you are not the one who handles insurance for the family. If your spouse scores equally poorly, time for the pair of you to decide whose job this is, and call your insurance agent to explain your health insurance to you, or find your benefits booklet and start reading it!

Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance Claims, Inc. a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, browse our past columns on our web site at www.micinsurance.com.

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