Health Insurance in the USA By: Jennifer Bates

Why do you need health Insurance? The purpose of health insurance is to help you pay for care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive. ... You need health insurance because you cannot predict what your medical bills will be. In some years, your costs may be low.

What does the Affordable Care Act really do? ACA ( Affordable Care Act) is a law enacted to ensure that all Americans have access to affordable health insurance. Affordable Care Act is 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.

What are the different kinds of Health insurance plan and why are they important? Part I Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Exclusive provider organizations (EPOs) An HMO delivers all health services through a network of healthcare providers and facilities. PPOs have a network of doctors, hospitals, and other providers who have agreed to charge less for plan members. Members of the health plan have access to a list of providers in the network by name and location. EPO is a network of individual medical care providers, or groups of medical care providers, who have entered into written agreements with an insurer to provide health insurance to subscribers.

Point-of-service (POS) plans What are the different kinds of Health insurance plan and why are they important? Part 2 (POS) is a type of managed care plan that is a hybrid of HMO and PPO plans. Like an HMO, participants designate an in-network physician to be their primary care provider. But like a PPO, patients may go outside of the provider network for health care services. A plan with a higher deductible than a traditional insurance plan. ... A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money free from federal taxes. Point-of-service (POS) plans High-deductible health plans (HDHPs), which may be linked to health savings accounts (HSAs)

What is a deductible? A deductible is the amount you pay for health care services before your health insurance begins to pay. How it works: If your plan's deductible is $1,500, you'll pay 100 percent of eligible health care expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance.

What is a Copayment? A health insurance copayment is a fixed amount established by an insurance plan for sharing the cost of certain health services between the insurance plan and the insurance customer. Insurance plans are a partnership between consumers and the company offering the policy. The cost-sharing system is a critical selling point for each plan. FYI: This is a fixed fee for certain kinds of office visit, prescription drugs, or other kinds of care. The health insurance copay lets you know ahead of time exactly how much you will owe. If your policy lists a health insurance copayment of 25 dollars for a doctor visit, you pay that amount each time you see the doctor

What is coinsurance? A type of insurance in which the insured pays a share of the payment made against a claim. Example: The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible. Let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%. If you've paid your deductible: You pay 20% of $100, or $20.

How do I know what is covered and what is not? If a service is covered, it means your health plan will pay for some or all of the cost. In most cases, your doctor also needs to be on the list of doctors that take your insurance, called a network. How much your health plan pays for depends on what type of care you use and where you get it. The best option to know if a service is covered is by paying attention to the itemized list of services that either your employer or insurance carrier gives to ensure that services are covered or not. Most times hospitals, facilities, or clinics will let you know the actual cost before actually performing the services to ensure they will be paid by you and the insurance carrier which is an contractual agreement.

How does health insurance come out of my paycheck? Deductions Paid With Pretax Dollars. If you earn $700 a week in gross wages and your health insurance premiums are $50 a week, your employer most likely deducts that $50, then calculates your tax withholding on the remaining $650

Questions?

Conclusion Sorry I couldn’t make the session but this power point presentation will answer any questions concerning health insurance.