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Now What? Health Insurance 101

Now What? Health Insurance 101. All You Need to Know Now That You’re Covered. Why is it so important?. Insurance Sounds Complicated!. Private Insurance. Medicare. Preventative Care. Co-Pay. Network. Insurance Card. Preauthorization. Limitations. Specialist. Office Visit. Urgent Care.

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Now What? Health Insurance 101

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  1. Now What? Health Insurance 101 All You Need to Know Now That You’re Covered

  2. Why is it so important?

  3. Insurance Sounds Complicated! Private Insurance Medicare Preventative Care Co-Pay Network Insurance Card Preauthorization Limitations Specialist Office Visit Urgent Care Deductible HMO Exclusions PPO Health Savings Account Formulary Out-Of-Pocket Limit Co-Pay Card Preferred Drug List Actuarial Value Primary Care Provider Medicaid Premium Emergency Room Co-Insurance Prior Authorization Gap Coverage Marketplace

  4. Relax and Take a Deep Breath!

  5. By the end of this section you will:

  6. Common Insurance Terms Karen Rubin Community Engagement Coordinator

  7. Payments

  8. Payments

  9. Money, Money… Moneyyyyyy

  10. Money, Money… Moneyyyyyy

  11. Red Tape

  12. Red Tape

  13. Doctors

  14. Doctors

  15. What is a Network?

  16. What is Managed Care?

  17. Let’s Talk About Different Kinds of Insurance Plans!

  18. Health Maintenance Organization

  19. Exclusive Provider Organization

  20. Preferred Provider Organization

  21. Point of Service

  22. Health Savings Account

  23. Decoding Your Insurance Card Member name and number: Your name is printed along with your member number. If your spouse or children are on your insurance plan, your member numbers may look similar. Coverage type: Type of insurance plan that you have. Group number: Used to track the specific benefits of your plan. The group number and member number are used to identify you. Co-pay and co-insurance: Amounts you pay for some covered services Phone numbers: Can be used to call your insurance company if you have any questions. May be on the back of your card.

  24. Preventative Screenings By: Erin Richardson

  25. By the end of this section you will:

  26. Preventative Health Screening a cost-effective way to find and treat health problems before they start or get worse

  27. Marketplace Plans and Preventative Screenings All Marketplace plans and many other plans must cover certain preventive services • No charge of copayment or coinsurance. • Even if you haven’t met your yearly deductible • Applies only when services are delivered by a network provider.

  28. Medicaid/Medicareand Preventative Screenings • Many preventive services are available without cost-sharing to individuals with new private health plans, Medicaid expansion plans, or Medicare

  29. 5 Categories of Preventative Screenings/Services • Lifestyle Screenings • Sexual Health Screenings • General Health Screenings • Screenings for Women • Vaccines

  30. Lifestyle Screenings • Alcohol abuse screening and counseling • Depression screening for adults • Tobacco Use screening for all adults • help with quitting is available

  31. Lifestyle Screenings (Marketplace Only) • Diet counseling • Obesity screening and counseling

  32. Sexual Health Screenings • HIV screening for everyone ages 13 to 65 • includes other ages at increased risk • Sexually Transmitted Infection (STI) prevention counseling • Syphilis, Gonorrhea, Hepatitis-C screening

  33. General Health screenings • Blood Pressure screening • Cholesterol screening • Colorectal Cancer screening • for adults over 50 • Diabetes (Type 2) screening

  34. Screenings for Women • Breast Cancer (Mammogram) screenings • every 1 to 2 years for women over 40 • Cervical Cancer screening • Every 24 months • Domestic and interpersonal violence screening and counseling • Osteoporosis screening • for women over age 60 depending on risk factors

  35. Vaccines • What is a vaccine? • Treatment(s) that build up your body’s defenses against certain infections

  36. Vaccines • Your physician knows best when it comes to vaccines • Practices vary by physician and by individual case • Always consult you HIV doctor when it comes to getting vaccinated

  37. How do vaccines work?

  38. Vaccines • Vaccines may cause more side effects for PLWHA • Vaccinations can increase viral load for a short period of time. • However, getting preventable diseases can be much worse. • Do not measure your viral load within 4 weeks of any vaccination.

  39. Vaccines • People with low CD4 cell count should talk to their doctor before getting a “live” vaccine • Chicken Pox • Shingles • Measles, Mumps, and Rubella (MMR)

  40. When to get Vaccinated

  41. When to Get Vaccinated

  42. How to get screened or vaccinated • Talk with your HIVdoctor • Schedule appointments as necessary • Keep a chart of screenings and vaccinations

  43. Vaccines • Your physician knows best when it comes to vaccines • Practices vary by physician and by individual case • Always consult you HIV doctor when it comes to getting vaccinated

  44. Create a Screening Schedule Within your packetthere are two assessment sheets that will help you create a personalized screening schedule

  45. Questions? Erin Richardson AmeriCorps Member Nueva Luz Urban Resource Center Phone: 216-651-8236 x 118 Email: erichardson@nlurc.org

  46. Picking Your Provider Matt Wovrosh Senior Community Engagement Coordinator

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