HEALTH INSURANCE

A way to help pay for health care when it is necessary What is it? A way to help pay for health care when it is necessary

Private Insurance Plans Blue Cross/Blue Shield United Health Care Kaiser Permanente Travelers Joe Smith Insurance Cigna

AMOUNT OF MONEY YOU PAY EVERY MONTH TO KEEP THE INSURANCE ACTIVE Premium AMOUNT OF MONEY YOU PAY EVERY MONTH TO KEEP THE INSURANCE ACTIVE

DEDUCTIBLE If you receive any kind of service, it is the amount of money you have to pay BEFORE the insurance company will pay Any money to the provider

CO- INSURANCE The percentage of the bill that you have to pay, and the percentage of the bill that your insurance company has to pay, AFTER THE DEDUCTIBLE HAS BEEN MET. Usually given as a fraction as 80/20, 90/10, 70/30

Co-payment The amount of money you have to pay at the time you receive care. Usually will be on your card.

Government Health Insurance Medicare Medicaid Peachcare Tricare

MEDICARE Insurance for persons 65 years old and older Persons who are disabled and have been on Social Security for 2 years Blind Individuals

MEDICAID Insurance for persons who have low or no income Persons receiving Kidney Dialysis

PEACHCARE Provides Insurance for children of families who have income, but not enough to purchase insurance. Does not cover the parents

TRICARE Insurance for Active Military Personnel and their families

Special Considerations HMO Health Maintenance Organizations Advantages Focus on wellness Pay for physicals Usually no deductibles Disadvantages Only can use their doctors & hospitals

PREFERRED PROVIDER ORGANIZATION PPO PREFERRED PROVIDER ORGANIZATION Insurance that gives you a list of doctors & hospitals that they will pay for They will cover other doctors, but not as well

Worker’s Compensation Insurance that will pay for any injuries that you get while on the job The employer pays the premiums

MANAGED CARE Program that began in the 90’s. Says : ALL HEALTH CARE MUST HAVE A PURPOSE or else insurance will not pay Advantage Keep cost of Health care down Disadvantage Often needs a second opinion Might not get what you believe you need

All insurance companies have a managed care department All insurance companies have a managed care department. They look at all the claims and decide if it is necessary. Usually before any service is given as surgery, therapies etc

How do you calculate how much you have to pay??? Start with how much you owe Subtract deductible Calculate co-insurance Add deductible back into your share Lets figure it out !!!

HOW DO YOU CALCULATE YOUR MEDICAL EXPENCES? Subtract deductible Figure out co-insurance amounts Complete final calculations LETS DO SOME MATH !!!

How to figure out insurance costs First look at the coverage JZ has Blue cross Insurance. Includes basic medical/ doctor & hospital. No dental coverage He pays $250 per month in premiums Deductible is 500 per calendar year Co-Insurance is 80/20

Now look at medical costs January Dr. visit for sore throat 100 Dental check up 150 Appendectomy 10000 June Stitches for laceration 150 Ankle sprain 100

Correct order Add up costs Apply deductible Apply the co-insurance

Costs $100 $10000 $150 $150 $100__________ _________ INSURANCE CO JZ $100 $10000 $150 $150 $100__________ _________ Total $10,350 $TOTAL 150

Apply deductible 10,350 Total cost of care - 500 paid by JZ DEDUCTIBLE 9,850 X .80 = 7880 (80% BY INS) 9,850 X .20= 1970 (20% by JZ)

Add deductible back into JZ cost Total cost of medical care for JZ 1970+ 500 = $2470 Total cost of medical care by insurance company $7880