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Health Insurance

Health Insurance. “You have to spend money to save money”. Respond to this statement. On this presentation, if a word is italicized , you should make a flash card over it! There may or may not be a word quiz in your very near future. Flashcards.

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Health Insurance

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  1. Health Insurance

  2. “You have to spend money to save money” Respond to this statement.

  3. On this presentation, if a word is italicized, you should make a flash card over it! • There may or may not be a word quiz in your very near future Flashcards

  4. DRG: fees based on Diagnostic-Related Groupings • Federal guidelines to keep costs reasonable • Premium: fee paid (usually monthly) to the insurance company in return for coverage • Ie $500/month • Personally, I pay around $20/month as a single person • “dependents” (children) or adding a spouse will increase your premiums • Deductible: amount paid by patient to the medical provider before insurance company will pay Definitions

  5. Co-payment: a specific amount of money paid for a service or medication visit • Ie $15 for an office visit • May or may not contribute to the deductible • Maximum out-of-pocket: the maximum amount of money the patient will pay • Once the max is reached, the insurance will pay in full • Co-insurance: where both the patient and the insurance company contribute to the cost of the service • May be used instead of a copayment OR in addition to it Definitions

  6. The higher the deductible, the lower your monthly premium Rule of Thumb

  7. Healthcare is a business in the US that makes up 15% of our economy • In 2004, $1.9 trillion was spent on health care • That comes out to $6000 per person! Healthcare Costs

  8. Predict: Where does the money go? • Expenses: • Cost of medical technology • Insurance administration • Lawsuits and malpractice • Aging population • Pharmaceutical (Drug) costs • Social problems • Ie. Violence, drug abuse, teen pregnancy, childhood obesity Why is Healthcare so Expensive?

  9. Services • Salaries • Products and supplies • Research and education Where does the Money Go?

  10. Fee for service: money that is paid at the time of service • Insurance plans • Definition: an agreement in which a person being insured pays a regular fee to an insurance company, and, in return, the company pays for certain healthcare expenses • Ie annual preventative care or catastrophic events • Yearly physicals, cancer treatment Methods of Payment

  11. Groups (work/employer) • Individuals • Self-employed • Employer does not offer insurance or you decide not to purchase it • Government benefits (military) Where Do You Get Insurance?

  12. Managed Care • Government Plans Types of Insurance

  13. Focuses on prevention • The Plan manages your care • Little booket that details your responsibility and protocol for seeking care • Ie needing a referral (that is, a recommendation from your doctor to see a specialist) • 2 types • HMO • PPO Managed Care

  14. Stands for Health Maintenance Organization • Group of physicians that provide complete coverage for members • Patient required to visit HMO doctors/facilities • Also must get referral to see a specialist • Lower premiums, smaller copayments BUT less freedom Managed Care: HMO

  15. Stands for “Preferred Provider Organization” • Very similar to an HMO, but with more freedom • You are still restricted to an “in-network” provider • However, you do NOT need a referral to see a specialist • May have to pay more in premiums or copayments, but you have more freedoms PPO

  16. Medicare • Federal Government Program • Provides healthcare for people over 65 or those with disabilities • Limited coverage • Many older individuals still need to purchase other plans so supplement their coverage Government Plans: -Care vs -Caid

  17. Medicaid • State run program • Pays for some coverage for poor or low-income people • Varying eligibility on a daily basis Government Plans: -Care vs -Caid

  18. There are a multitude of other plans out there, but HMOs, PPOs, and government plans are one of the most popular • Other Plans: • HDHP: High Deductible Health Plan • This means that you have a high deductible, but lower premiums • What does that mean in plain English? • Purchased “just in case” of a catastrophic event • Why would this plan be a good idea? • Comes with a Health Savings Account (HSA) • Savings account that can be used for medical expenses that is not taxed like accounts are • Money can roll over, year to year, if not used • Can be used on things like copays, deductibles, coinsurance, even childcare Other Plans

  19. Traditional Plans • Point of Service (POS) Plans • Flexible Spending Account (FSA) • Special savings account that is taxed differently by the government • The money can be spent on things like copays • Use it or lose it: If you don’t spend it, you will use it at year’s end! • Often comes with a debit card to access funds Other Plans

  20. Get into groups of 4 • 2 of you will be insured • You have to pay a monthly premium of $250, BUT you also get care/treatment at a lower price • 2 of you will be uninsured • You only have to pay for treatment • Use your budget handout sheet to keep track of your expenses and answer the follow up questions to analyze your budget Let’s Play a Game

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