Insurance, the Healthcare Crisis, and the ACA
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Insurance, the Healthcare Crisis, and the ACA. Question 1 - 10. What kind of insurance did Ms. Mueller have?. Answer 1 – 10. Cigna PPO. Question 1 - 20. What is the difference between a copay and coinsurance?. Answer 1 – 20. Copay = fee that is paid at the time of service

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Insurance, the Healthcare Crisis, and the ACA

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Insurance the healthcare crisis and the aca

Insurance, the Healthcare Crisis, and the ACA


Question 1 10

Question 1 - 10

  • What kind of insurance did Ms. Mueller have?


Answer 1 10

Answer 1 – 10

  • Cigna PPO


Question 1 20

Question 1 - 20

  • What is the difference between a copay and coinsurance?


Answer 1 20

Answer 1 – 20

  • Copay = fee that is paid at the time of service

    • Must be paid no matter where you are in the deductible

  • Coinsurance = where the expenses are split between the patient and the insurance company after the deductible has been reacher


Question 1 30

Question 1 - 30

  • What is the difference between an HMO and a PPO?


Answer 1 30

Answer 1 – 30

  • HMO: an insurance plan where you are restricted to a set of doctors

    • You must have a referral to see a specialist

    • Important for doctors to be “in-network”

  • PPO: an insurance plan where you do not need a referral to see a specialist

    • Insurance pays SOME for “out of network” visits


Question 1 40

Question 1 - 40

  • Where are 3 places where you can receive health insurance?


Answer 1 40

Answer 1 – 40

  • Employer, private, government


Question 1 50

Question 1 - 50

  • Compare and contrast Medicare and Medicaid


Answer 1 50

Answer 1 – 50

  • Medicare and Medicaid are both government insurance plans.

  • Medicare = elderly (age 65 and up)

  • Medicaid = low-income


Question 2 10

Question 2 - 10

  • What is 20% of $650?


Answer 2 10

Answer 2 – 10

  • $130


Question 2 20

Question 2 - 20

  • For this medical insurance, there are no copays or deductibles. There is an 80/20 coinsurance.

    • Drs office visit: $130

    • Prescription: $70

    • X-ray: $1300

  • How much would the patient pay?


Answer 2 20

Answer 2 – 20

  • $300


Question 2 30

Question 2 - 30

  • A health plan excludes vision and dental. There is a $750 deductible and a 70/30 coinsurance.

    • Eye exam: $75

    • Knee Surgery: $5000

    • Drs. Visit: $130

  • How much would the patient pay?


Answer 2 30

Answer 2 – 30

  • 75 + 750 + 1314 = 2139


Question 2 40

Question 2 - 40

  • A vision plan includes an eye exam and a $15 copay for glasses. The health plan has a $500 deductible and 80/20 coinsurance

    • Eye appointment: $100

    • Glasses: $150

    • Physical: $50

    • Prescription: $35

  • How much will the patient pay?


Answer 2 40

Answer 2 – 40

  • $15 copay for glasses

  • $0 for eye appointment

  • $85 for medical bills

  • Total: $100 (did not meet deductible)


Question 2 50

Question 2 - 50

  • A health plan includes dental (2 cleanings/year) and general health, but not vision. There is a $1000 deductible and 80/20 coinsurance.

    • 2 teeth cleanings: $130 each

    • Chiropractor visits: $500

    • Prescription: $130

    • Drs office visits: $200

  • What will the patient pay?


Answer 2 50

Answer 2 – 50

  • $0 for dental visits

  • $830 (did not meet deductible)


Question 3 10

Question 3 - 10

  • What percentage of Americans are currently uninsured?


Answer 3 10

Answer 3 – 10

  • ~16-18%


Question 3 20

Question 3 - 20

  • What are the two reasons a person may be uninsured?


Answer 3 20

Answer 3 – 20

  • Possible answers: Cannot afford insurance, employer insurance not offered, denial for pre-existing conditions


Question 3 30

Question 3 - 30

  • What is COBRA?


Answer 3 30

Answer 3 – 30

  • States that a person laid off from their job can still use their health plan for 18 months after becoming unemployed, but must pay the entire premium.


Question 3 40

Question 3 - 40

  • Why might a disabled person not have insurance?


Answer 3 40

Answer 3 – 40

  • Denial b/c of preexisting condition

  • Cost

    • Premiums inflated because of health status

    • Cannot work so cannot afford cost


Question 3 50

Question 3 - 50

  • Why might a person who is HIV+ not have insurance?


Answer 3 50

Answer 3 – 50

  • 1) cost

  • 2) pre-existing condition

  • 3) gov’t benefits don’t kick in until they are very sick


Question 4 10

Question 4 - 10

  • True or false: Small businesses are fined if they do not offer their employees insurance.


Answer 4 10

Answer 4 – 10

  • False: large employers are fined


Question 4 20

Question 4 - 20

  • What is the Individual Mandate?


Answer 4 20

Answer 4 – 20

  • Provision that states that all people must have health insurance or else pay a fine


Question 4 30

Question 4 - 30

  • How old can a young person stay under his/her parents’ health plans?


Answer 4 30

Answer 4 – 30

  • 26


Question 4 40

Question 4 - 40

  • Give me 2 provisions that the insurance companies would dislike.


Answer 4 40

Answer 4 – 40

  • Possible answers:

    • Guaranteed coverage

    • Cannot base premiums off of health status

    • Cannot drop coverage because you are sick

    • No lifetime limits


Question 4 50

Question 4 - 50

  • What are your options if you make too much for Medicaid, but too little to afford private insurance under the ACA?


Answer 4 50

Answer 4 – 50

  • Government subsidies


Question 5 10

Question 5 - 10

  • What is Ms. Mueller’s favorite color?


Answer 5 10

Answer 5 – 10

  • Purple


Question 5 20

Question 5 - 20

  • True or false: Ms. Mueller has held a snake before.


Answer 5 20

Answer 5 – 20

  • True!


Question 5 30

Question 5 - 30

  • What is Ms. Mueller’s alarm set for in the mornings?

    • A: 6:30

    • B: 3:00

    • C: 4:30

    • D: Ms. Mueller never sleeps


Answer 5 30

Answer 5 – 30

  • 4:30 (although I press the snooze a few times before getting up)


Question 5 40

Question 5 - 40

  • How much was taken out of Ms. Mueller’s paycheck for her health insurance?


Answer 5 40

Answer 5 – 40

  • Around $20


Question 5 50

Question 5 - 50

  • What time is Ms. Mueller’s bedtime?

    • A) 11:00

    • B) 10:30

    • C) Ms. Mueller doesn’t sleep

    • D) 9:30


Answer 5 50

Answer 5 – 50

  • 9:30


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