Health Insurance Terms Quiz: Deductibles, Copays & More
Health insurance key terms quiz.
Health insurance paperwork can be one of the most frustrating parts of navigating the healthcare system. Terms like deductible, coinsurance, and prior authorization appear on Explanations of Benefits (EOBs) and plan documents — and misunderstanding them can lead to unexpected bills. This quiz covers eight essential insurance concepts to help you compare plans, budget for healthcare costs, and understand statements when they arrive. Each explanation is written in plain English, not insurance-industry language.
Interactive Quiz0/8 answered
Question 1 of 8
Your health insurance premium is:
Explanation: The premium is like a subscription fee — you pay it every month whether or not you use healthcare services, in exchange for coverage.
Question 2 of 8
Your deductible is the amount you must pay:
Explanation: The deductible is your annual threshold. Once you've paid that amount yourself, your insurer starts covering its share of most services (though copays and coinsurance often still apply).
Question 3 of 8
A copay is:
Explanation: A copay is a flat fee — $20 for a primary care visit, $50 for a specialist, regardless of the total bill. Copays are usually due at the time of service.
Question 4 of 8
Coinsurance means:
Explanation:Coinsurance is a percentage split. After your deductible, you might pay 20% of a $1,000 hospital charge ($200) while the insurer pays 80% ($800).
Question 5 of 8
Your out-of-pocket maximum is the most you will pay in one year, after which:
Explanation: Once you hit your out-of-pocket max, your insurer pays 100% of covered, in-network services for the remainder of that plan year — deductibles, copays, and coinsurance all count toward this cap.
Question 6 of 8
An EOB (Explanation of Benefits) is:
Explanation: An EOB is not a bill — it's a summary of how a claim was processed. It shows the billed amount, the insurer's allowed amount, what was paid, and what you are responsible for. Always compare it to the actual bill you receive.
Question 7 of 8
Prior authorization (PA) means:
Explanation:Prior authorization is your insurer's pre-approval process. For certain drugs, surgeries, or imaging, your provider must submit clinical evidence that the service is medically necessary before coverage is granted.
Question 8 of 8
A formulary in prescription drug coverage is:
Explanation: A formulary is your plan's drug list. Tier 1 (generics) costs least; Tier 2 (preferred brands) costs more; Tier 3+ (non-preferred or specialty drugs) may require PA or cost significantly more.
