Health Insurance Law and You Mr. Blais

Managed Care Plans These involve arrangements between the insurance companies and a certain network of health-care providers (Doctors and hospitals) – These are commonly offered by employers and there are strong incentives to use in-network services Three common types are: – HMO – Health Maintenance Organization – POS – Point-of-Service Plan – PPO – Preferred Provider Organizations

Terms to Know Co-Payment: – A flat fee that you have to pay every time you visit a doctor, hospital, or health care provider (Generally $10- $25) Deductible: – Amount you have to pay to the insurance company annually before your insurance kicks in Co-Insurance: – Percentage of the medical costs that you pay after you reach any deductibles that apply (common on out of network procedures)

HMO Offers access to a relatively large network of physicians, hospitals, and other facilities (Varies based on insurance company) You MUST choose a Primary Care Physician (PCP) PCP must refer you to ANY specialist (or it won’t be covered) Usually does NOT have a deductible but generally requires small co-payments for doctor visits and prescriptions Most out-of-network visits aren’t covered at all

POS Offers access to a network of physicians, hospitals, and other facilities (Varies based on insurance co.) You MUST choose a Primary Care Physician (PCP) PCP can but does not have to refer you to specialists If PCP refers you either in-network or out-of-network insurance will cover all or most of the bill Usually does NOT have a deductible You CAN refer yourself to out-of-network doctors/hospitals however even if the service you get is normally covered by your policy you will still likely have to pay some co-insurance

PPO Doctors, hospitals, and health care providers are paid by the insurance company on a negotiated fee schedule. (Varies based on insurance co.) You DO NOT need a Primary Care Physician (PCP) You can refer yourself both in-network and out-of- network however costs are generally lower if you stay in-network Usually DOES have an annual deductible However like the POS if you refer yourself to out-of- network you will likely have to pay some co-insurance

Medicaid and Medicare Medicaid: A public assistance program that is administered by the states for people whose incomes and resources are not enough to pay for private insurance. [Eligibility and coverage vary from state to state] Medicare: A federal government program for people 65 and older (or people with certain disabilities ) that pays a portion of costs for hospitalization, prescriptions, surgery, and doctor’s bills.

Basic Types of Coverage Hospital Expense: Room, Board, and Service costs while hospitalized Surgical Expense: Surgeons fees and other fees for surgery Physicians Expense: Visits to the doctors office Lab Expense: X-rays, lab tests, MRI, and CAT Scans

Addition Types of Coverage These may or may not be covered under certain insurance plans: Dental Care Chiropractic Care Maternity Care Vision Care Mental Health Care Preventive Care Prescription Drugs Participating in employer health plans savings you a lot of money because they buy in bulk so premiums are lower. Plus employers also contribute to the price of the premium.

Ways to Save Money Prevention – Stay healthy and get frequent check-ups Try cutting costs on prescription drugs (Buy generic brands and buy in bulk) Join health plans with your spouse Check bills – Be sure you’re only charged for procedures you’ve had Get to know your company – ask for discounts and negotiate prices Shop Around Check for health care incentives (gym memberships, forms of prevention and fitness)