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Health Insurance

What Do I Already Know About Health Insurance?

Health insurance is a topic that is frequently in the news. Therefore, you may already know some things about this topic from news reports, advertisements, or personal experiences receiving health care services.

Reflect on the following five questions below.

1. What personal experiences have you had as a health insurance consumer?

2. What personal observations have you had about receiving health care services and using health insurance?

3. What have you heard or read about health insurance?

4. What television shows, movies, or advertisements relate to the topic of health insurance?

5. What questions do you have about health insurance?                  

 

 

 

After watching the videos and going through the powerpoint, answer the following questions.

How does health insurance work?

What are the financial benefits of having health insurance?

What is the term used to describe the payment made to maintain a health insurance policy?

How does the term “safety in numbers” apply to health insurance?

What is a policy?

What is coverage?

What is the term used to describe the amount of money that policyholders must pay themselves for health care services before health insurance benefits begin?

What is the term for when policy holders want their insurance policy to pay for a loss?

The amount that an insured person will pay before the insurance company pays is called…

What is the relationship between insurance premiums and deductibles?

With an unpaid $1,000 annual deductible and $800 medical bill, how much will insurance pay?

What is the term used to describe the set price (e.g., $15) that people pay when they see a doctor?

What is the term used to describe the percentage of covered medical expenses paid by health insurance after the annual deductible is met?

What is the rule of 3 when selecting a health care provider?

What should the consumer consider when comparing health care providers?

The affordable care act expects all Americans to ….

In general, the higher percentage of expenses that an insurance company covers, the more the consumer will pay for the ______________ but the smaller the ___________________ are likely to be.

What are the following types of coverages called?

  • Offered a list of doctors within a network to choose from; they either work directly for the HMO or contract with it. You will pick a primary care physician who will oversee all your care, including providing referrals to specialists as needed.
  • These plans will have a list of pre-approved providers they contract with, rather than providers who work directly for the plan. While reimbursement percentages vary for going out of network, a 60/40 split is common, where the insurer pays 60 percent and you cover the remaining 40.
  • contracts exclusively with specific doctors, hospitals and other health care providers to form a network. EPO clients know they don't have many options when it comes to providers, but they do have the comfort of knowing they'll always be reimbursed for any in-network expenses.
  • hybrid of HMO and PPO

 

What are the 7 rules for health care?

 

 

Let's say your health insurance plan has the following features:

• Deductible: $500

• Coinsurance: 80/20 (you pay the 20%; insurance company pays 80%)

• Out-of-Pocket Maximum: $5,000

Now, let's say that you go to the hospital and incur $7,500 worth of medical expenses. How much do you have to pay out of pocket?

What would be your out-of-pocket cost for $20,000 of annual medical expenses?

What would be your out-of-pocket cost for $40,000 of annual medical expenses?

 

 

 

 

 

In addition to the powerpoint and video, use this link as an additional source to answer the following questions.

https://consumersunion.org/wp-content/uploads/2014/11/Metal_Tiers_FAQs_-CA.pdf

Why are health insurance plans sold in Marketplaces labeled with the names of metals like the medals given to athletes at the Olympics?

What is the relationship between metal tiers and health insurance premiums?

What do you notice about the sample cost numbers in Table 1?

What is a Catastrophic plan?

If you had to choose your own health insurance right now, which metal would you choose?

How can consumers decide which metal tier health insurance plan is right for them?

Susan sees a doctor 12 times a year and gets a non-preferred brand drug prescription refilled monthly.

  • Using the sample cost data in Table 1, what would be her total anticipated annual expenses (premium plus out-of-pocket expenses) for a Bronze plan and Gold plan?

 

Critical Thinking Questions-Please respond with a one paragraph response.

Why do you think health insurance is becoming more expensive?

Do you think it is fair to require all citizens to pay for health insurance? Why or why not? 

Timothy Brady

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