Mr. Woodington’s Money Management II

 Options for individuals seeking health insurance not covered by their employer  Tips for purchasing individual health insurance plans  Government provided health care programs  Medicare  Medicaid

 The majority of citizens receive health care coverage through employer provided programs  Reasons people do not receive coverage through their employer:  Not offered/eligible  Self-employed  Too expensive for individual to purchase

 Individuals who do not receive coverage from an employer or qualify for a government program, will have to purchase an individual health insurance plan  These options mirror those offered by employers, including HMOs and PPOs  Individually purchased, coverage is more difficult/expensive to purchase  Policies are individually underwritten  Complete medical history is under scrutiny

 Be honest!  Disclose ALL medical problems you have had, no matter how insignificant it may seem  Insurance companies may write a provision, called a rider, into your policy which will not pay for any pre- existing conditions  Insurance companies may cancel your policy using a practice called rescission.  This occurs when they have received a claim you have filed and reviewed your application and medical history for undisclosed conditions or inconsistencies

 Buy! But only what you need  Over 60 percent of bankruptcies in the US are the result of medical bills  Review your risk management strategies  What risks can you afford to take?  What risks can you not afford to take?  Deductible amount?  Married? Use your spouse’s coverage!  The job may not provide much in compensation beyond the health care coverage, yet this may be the difference when faced with catastrophic illnesses

 Federally funded health insurance program  Available to people:  Over 65 years of age  With certain disabilities  Permanent kidney failure  Lou Gehrig’s disease  Medicare helps with the cost of health care but does not cover all expenses

 Part A – Hospital Insurance  Covers the cost of inpatient care  Participants may have to pay a single annual deductible, may receive coverage at no cost  Part B – Medical Insurance  Covers a variety of doctor and medical services not covered, or fully covered, by Part A  Has a deductible and coinsurance provision

 Part C – Medicare Advantage Plans  Combines Parts A & B  Coverage is provided by private insurance companies approved by Medicare  Cost may be lower than original Medicare plan  Extra benefits provided  Part D – Prescription Drugs  Voluntary to join  Requires a monthly premium  Coverage is provided by approved, private insurance companies

 Although Medicare effectively covers many medical costs, there are some expenses it will not cover:  Certain types of skilled or long-term nursing care  Routine checkups  Out-of-hospital prescription drugs  Dental care  Most screening tests & immunizations  Medicare also limits the amount it will pay for the services it does provide. Any difference between Medicare’s approved amount and the final bill is the patient’s responsibility

 Provides health care coverage for:  Lower income individuals & families  The elderly & people with disabilities  Financed through a combination of state and federal funds  Administered by individual states  Eligibility is determined by a number of factors. Check with individual states for specific qualificationsindividual states

 Although specific coverage varies from state to state, Medicaid is typically comprehensive enough so people do not need supplemental insurance.  Typical Medicaid benefits include  Physicians’ services  Hospital inpatient and outpatient services  Lab services  Skilled nursing & home health services  Prescription drugs  Eyeglasses  Preventive care for people under 21

 Individuals who do not receive health insurance coverage through their employer have options!  Purchasing individual health insurance policies can be more difficult. It is important to be honest and consider other options.  The government provides health care coverage through Medicare and Medicaid. Each has specific criteria for eligibility and provides varying coverage options.