Health Insurance Mr. Peterson

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 Protect against economic loss in the event of serious accidents or illnesses.  Protect against the rising cost of health care, which is outpacing other costs in general. Importance of Health Insurance

 Private Insurance  Available to individuals or families  Provided as group health insurance plans through various employers  Government Health Insurance Plans  Medicare  Medicaid  Workers’ Compensation What are my options?

 Fee-for-service plans (Indemnity)  Pay deductible plus a percentage of eligible costs before insurance will pay  80/20  Co-pay  Pays for medical tests and prescription drugs as well as hospital and doctor fees Private Insurance

 Managed Care Plans  Contract with specific doctors and other health care providers  Charge monthly fees plus small co-payments for service  No deductible  Health Maintenance Organizations (HMOs)  Preferred Provider Organizations (PPOs) Private Insurance

 Provide a list of participating doctors  Must go through primary care doctor for other treatments  Go outside the plan, pay the bill Health Maintenance Organizations (HMOs)

 Insurance company or provider contracts with network of physicians and hospitals  Network agrees to accept a negotiated fee for services provided to PPO customers  Lower cost to stay in network Preferred Provider Organizations (PPOs)

 Primary care doctor supervises plan and makes referrals  Pay more for nonparticipating specialists Point-of-service (POS) plans

 Premiums  Amount you or your employer pay monthly  Co-insurance  Amount or share of the costs you must pay for services  20% up to a stated annual maximum  Deductible Indemnity and Managed Care

 Preauthorization  Utilization Reviews  Assessment of appropriateness and necessity  Pre-existing conditions  Renewability Indemnity and Managed Care

 Maximum Benefits  Open enrollment period  Enroll in plan or change coverage options  Exclusions  Mental health care, dental, etc… Indemnity and Managed Care

 Coverage  Benefit packages and care providers  Premiums and deductible  Uncovered costs  Conversion to individual plan Choosing a Plan

 Consolidated Omnibus Budget Reconciliation Act  At your expense, you can continue your previous employer’s coverage for up to 18 months after you leave the job. WHY DOES THIS MATTER? COBRA

How the Most Common Types of Health Plans Compare Which would you rather have?

 Medicare  65 and older (disabled individuals under 65)  Health insurance administered by Social Security  Funded by payroll taxes paid by employers, employees (half premium), and the self-employed (full premium)  Covers inpatient for 150 days Government Health Insurance Plans

 Part A- Basic hospital coverage (deductible)  Provided free for those who qualify  Covers hospital room and board  Deductibles apply  Part B – Supplementary medical insurance  Optional for a monthly premium if eligible for Part A  Covers doctors and surgeons, lab tests, x-rays, and possibly some home health care.  Financed by government and monthly premiums Medicare

 State administered for people of low economic means  Federal government funded with state and local tax  Eligibility and levels of coverage vary by state  Home health care  Dental and eye care  Prescription drugs Medicaid

 Mandatory health insurance that compensates workers for job-related illness or injury.  Premiums paid by employers.  Premiums based on merit; employers who file the most claims pay the highest rates  State administered; coverage varies. How does this compare to the others? Workers’ Comp

 Insured’s health  Family health history  Occupation or hobbies  Gender  Women live longer, and in turn pay less. Why?  Age of insured  Pay more as you get older. Why? Factors Affecting Cost

 case-study.html case-study.html Real Life Scenario

 Get into groups of 2 or 3.  Discuss each of the following cases.  Would you accept or decline the person in the case?  Why or why not?  Would you make this person pay more or less? Group Time

 26 years old  Male  Previous family history of heart problems  No major medical surgeries  Works in a mine Case 1

 Female  45 years of age  Chain smoker  Librarian  No history of major family issues  Clean bill of health Case 2

 Male  35 years of age  Falls under the definition of obese  Works a minimum wage job  Had a major illness when 12  No family history of illnesses Case 3

 Female  53 years old  Family history of cancer  Works in a car factory  Clean bill of health Case 4