1. What do you think is the average cost for the following…
Emergency room visit
$1,318
Ambulance ride
$1,099
Broken arm (non-surgical treatment)
$2,500
Having a baby at a hospital
$13,000!

2. Health Insurance

3. Kinds of Coverage Medical Dental Vision
(hospital visits, normal doctor visits, etc)
Dental
Vision

4. Terminology Deductible Co-Payment (Co-Pay) Out-of-pocket maximum
Expenses add up through the year to meet your deductible
Not paid for every injury
EX: If my deductible is $500 and I have 3 hospital visits that cost $500 total, my next hospital visit will be covered by insurance
Co-Payment (Co-Pay)
The amount you pay up front for each time you receive medical services
Counts toward the total medical bill
Does not count toward your deductible
Out-of-pocket maximum
The maximum amount you are required to pay in health expenses in one year
Insurance company pays 100% of all costs after that

5. Terminology In-Network provider Out-of-network provider
A doctor who is in your health plan’s preferred (discounted) group
Cheaper
Out-of-network provider
A doctor who is NOT in your health plan’s preferred (discounted group)
More expensive
Many terms we discussed in our first section of notes (How Insurance works) also apply to health insurance
Co-insurance
Premiums

6. Types of Insurance Plans
PPO
HMO
“Preferred Provider Organization”
Provides a larger selection of “in-network” doctors than an HMO plan
Costs more than an HMO
“Health Maintenance Organization”
Smaller choice of “in-network” doctors than PPO
Costs less than a PPO

7. Government Health Insurance Plans
Medicare
Health insurance for elderly people
Medicaid
Health insurance for low-income families

8. Changes with Obamacare
No lifetime caps
Can’t be denied due to a pre-existing condition
Stay on your parents insurance until you are 26
Free birth control (unless you work for a faith-based organization)
Almost everyone is required to have health insurance
Penalties are assessed if you don’t

9. Quick Review
What is the limit called where after you’ve paid a certain amount, you no longer have to pay any more for medical expenses?
What is it called when you have to pay a small amount every time you visit the doctor?
Between in-network and out-of-network, which doctors are cheaper to visit?
Which of the different types of health insurance plans tends to be the most expensive, but also offers the largest selection of in-network doctors?
Out-of-pocket maximum
Co-pay
In-network
PPO

10. Nicki’s Story….
Nicki was dared to off the roof of her house into a pool. With an immense amount of peer pressure and her friend at her side, this happened…..

11. Nikki’s Story
Nikki was taken to the hospital where she was told she had a broken ankle. The cost to pay her broken ankle was $1,000
How much of this $1,000 would Nikki need to pay out of her own pocket?
It depends……

12. Nikki’s Story
How much would she need to pay if she’s already reached her out-of-pocket maximum?
NOTHING!
Assuming she hasn’t reached her out-of-pocket maximum, what is the first thing Nikki would need to pay while she was in the hospital?
Co-Payment
How much of the $1,000 would she need to pay if she hasn’t reached her deductible of $2,500?
ALL OF IT!

13. Nikki’s Story
Assuming Nikki HAS reached her deductible amount of $2,500 and that her health insurance has 50/50 co-insurance coverage, how much of the $1,000 would she need to pay?
$500