Your result
How many did you get right out of 15?
12 to 15You know where health insurance stops. Few people do until a claim is denied.
7 to 11You have the broad picture. The items you missed are the ones worth checking in your own plan this week.
0 to 6Most people would score here. The gaps are not advertised, and several of the rules run against intuition.
Three questions that reveal what your plan covers
- Is it medical care, or help with daily life? Insurance pays for treatment. It does not pay for custodial care or lost income.
- Is the patient a child or an adult? Dental and vision care are required benefits for children and optional extras for adults.
- Who makes the rule? Federal law sets a floor. States add to it. Self-funded employer plans follow federal rules only. Your plan’s summary of benefits has the final word.
All fifteen answers
| 1 | Breast pump: covered. |
| 2 | Long-term nursing home care: not covered. |
| 3 | Reconstruction after mastectomy: covered. |
| 4 | Adult eyeglasses: not covered. |
| 5 | A child’s eye exam and glasses: covered. |
| 6 | IVF: depends on the plan and the state. |
| 7 | Routine care in a clinical trial: covered. |
| 8 | Over-the-counter medicine: not covered, but HSA and FSA money can pay. |
| 9 | A newborn: covered only if enrolled in time. |
| 10 | Hearing aids on Original Medicare: not covered. |
| 11 | Therapy: covered. |
| 12 | A hospital stay abroad on Original Medicare: not covered. |
| 13 | Chiropractic care: depends on the plan and the state. |
| 14 | Lost wages: not covered. |
| 15 | A drug that is not on the list: sometimes, through an exception. |
Keep reading
- Covered. But How Much Will You Actually Pay?
- 7 Unexpected Health Insurance Costs You Might Be Missing
- Next quiz: Pay It or Question It? 15 Medical Bills
- Next quiz: Real or Scam? 15 Calls, Texts and Letters
Sources: HealthCare.gov, essential health benefits, preventive services for women and Special Enrollment Periods; Medicare.gov, coverage of skilled nursing care, hearing aids, chiropractic services and care outside the United States; U.S. Department of Labor, Women’s Health and Cancer Rights Act and mental health parity guidance; Internal Revenue Service, Publication 969. The situations in this quiz are illustrations. Coverage always depends on your specific plan, so confirm with the plan before relying on any answer here.