PF Chapter 9

What Can You Do to reduce personal health care costs

- Eat a balanced diet, and keep your weight under control - Avoid smoking, and don't drink to excess - Get sufficient rest, relaxation, and exercise - Drive carefully, and watch out for accident and fire hazards in the home - Protect yourself from medical ID theft

Managed care is offered by which of the following?

- Health maintenance organizations - Point-of-service plans - Preferred provider organizations

Which of the following is part of the Patient Protection and Affordable Care Act?

- Tax credits for small business - Prohibits denying coverage to children with preexisting medical conditions - Bans insurance companies from dropping people when they get sick

What are the sources of disability income coverage?

- Worker's compensation - Employer Plans Social Security

What Is Being Done about the High Costs of Health Care

-Programs to carefully review health care fees and charges and the use of health care services - The establishment of incentives to encourage preventive care and provide more services out of hospitals, where this is medically acceptable. - Involvement in community health planning to help achieve a better balance between health needs and health care resources. - The encouragement of prepaid group practices and other alternatives to fee-for-service arrangements. - Community health education programs that motivate people to take better care of themselves. - Physicians encouraging patients to pay cash for routine medical care and lab tests.

Major Provisions in a Health Insurance Policy

A copayment is a flat fee that you pay every time you receive a covered service.

Preferred Provider Organizations

A variation on the HMO is a preferred provider organization (PPO), a group of doctors and hospitals that agree to provide specified medical services to members at prearranged fees. PPOs offer these discounted services to employers either directly or indirectly through an insurance company. The premiums for PPOs are slightly higher than the premiums for HMOs. A point-of-service (POS) plan combines features of both HMOs and PPOs. POSs use of network of participating physicians and medical professionals who have contracted to provide services for certain fees. As with your HMO, you choose a plan physician who manages your care and controls referrals to specialists. As long as you receive care from a plan provider, you pay little or nothing, just as you would with an HMO. However, you're allowed to seek care outside the network at a higher charge, as with a PPO.

High Medical Costs

Affordable health care has become one of the most important social issues of our time. News broadcasts abound with special reports on "America's health care crisis" or politicians demanding "universal health insurance"

Health Insurance and the Patient Protection and Affordable Care Act of 2010

Americans had been debating for years whether the nation needs health care reform to ensure that we get high-quality, affordable health care.

Which Coverage Should You Choose

Any of these three choices will take care of at least some of your medical expenses. Ideally, you should get a basic plan and a major medical supplement. Another option is to purchase a comprehensive major medical policy that combines the value of both plans in a single policy. Health Insurance Must-Haves describes the most basic features you should look for

Why Does Health Care Cost So Much

Because third parties-- private health insurers and government -- pay such a large part of the nation's health care bill, hospitals, doctors, and patients often lack the incentive to make the most economical use of health care services.

Sources of Disability Income

Before you buy disability income insurance from a private insurance company, remember that you may already have some form of insurance of this kind. This coverage may be available through worker's compensation if you're injured on the job. Disability benefits may also be available through your employer or through Social Security in case of a long-term disability.

Hospital and Medical Service Plans

Blue Cross provides hospital care benefits. Blue Shield provides benefits for surgical and medical services performed by physicians.

Major Medical Expense Insurance Coverage

Chen would have been better protected if he had had major medical expense insurance. This coverage pays the large costs involved in long hospital stays and multiple surgeries. In other words, it takes up where basic health insurance coverage leaves off. Almost every tyhpe of care and treatment prescribed by a physician, in and out of a hospital, is covered. Maximum benefits can range from $10,000 to more than $1 million per illness per year. Of course, this type of coverage isn't cheap. To control premiums, most major medical plans require a deductible. Some plans also include a coinsurance provision. Coinsurance is the percentage of the medical expense s the policyholder must pay in addition to the deductible amount. Many policies require policyholders to pay more than 25 percent of expenses after they have paid the deductible. Stop-loss is a provision that requires the policyholder to pay all costs up to a certain amount, after which the insurance company pays 100 percent of the remaining expenses, as long as they are covered in the policy. Major medical expense insurance may be offered as a single policy with basic health insurance coverage, or it can be bought separately. Comprehensive major medical insurance is a type of complete insurance that helps pay hospital, surgical, medical, and other bills. It has a low deductible, usually $500 to $1,000.

What is Health Insurance

Health insurance is a form of protection that eases the financial burden people may experience as a result of illness or injury. You pay a premium, or fee, to the insurer. In return, the company pays most of your medical costs. Although plans vary in what they cover, they may reimburse you for hospital stays, doctors' visits, medications, and sometimes vision and dental care.

Basic Health Insurance Coverage

Includes hospital expense coverage, surgical expense coverage, and physician expense coverage.

Deductibles and Coinsurance

It can also be affected by the terms of the coinsurance provision (which states what percentage of the medical expenses the policyholder must pay in addition to the deductible amount.)

Long waiting period ---> ______Premiums Short waiting period ---> ____ Premiums

Lower Higher

Health Maintenance Organizations

Managed Care refers to prepaid health plans that provide comprehensive health care to their members. Managed care is designed to control the cost of healthcare services by controlling how they are used. A health maintenance organization (HMO) is a health insurance plan that directly employs or contracts with selected physicians and other medical professionals to provide health care services in exchange for a fixed, prepaid monthly premium. HMOs are based on the idea that preventive services will minimize future medical problems. Therefore, these plans typically cover routine immunizations and checkups, screening programs, and diagnostic tests. They also provide customers with coverage for surgery, hospitalization, and emergency care. Supplemental services may include vision care and prescription services, which are typically available for an additional fee

Physician Expense

Meets some or all the costs of physician care that do not involve surgery. This form of health insurance covers treatment in a hospital, a doctor's office, or even a patient's home. Plans may cover routine doctor visits, X rays, and lab tests. Like surgical expense coverage, physician expense coverage specifies maximum benefits for each service. Physician expense coverage is usually combined with surgical and hospital coverage in a package called basic health insurance.

Your Disability Income Needs

Once you have found out what your benefits from the numerous public and private sources would be, you should determine whether those benefits would meet your disability income needs. Ideally, you'll want to replace all the income you otherwise would have earned. This should enable you to pay your day-to-day expenses while you're recovering.

Surgical Expense

Pays all or part of the surgeon's fees for an operation, whether it is done in a hospital or in the doctor's office. Policies often have a list of the services that they cover, which specifies the maximum payment for each type of operation.

Hospital Expense

Pays for some or all of the daily costs of room and board during a hospital stay. Routine nursing care, minor medical supplies, and the use of other hospital facilities are covered as well.

Medicare

Perhaps the best-known government health program is Medicare. Medicare is a federally funded health insurance program available mainly to people over 65 and to people with disabilities.

Coinsurance is a provision under which the _____ share the covered losses.

Policy and the insurer

Private Health Care Plans

Private health care plans may be offered by a number of sources: private insurance companies; hospital and medical service plans; health maintenance organizations; preferred provider organizations; home health care agencies; and employer self-funded health plans.

Disability Income Insurance

Provides regular cash income when you're unable to work because of a pregnancy, a non-work-related accident, or an illness. It protects your earning power, your most valuable resource.

Private Insurance Companies

Several hundred private insurance companies are in the health insurance business. They provide mostly group health plans to employers, which in turn offer them to their employer as a benefit.

Waiting or Elimination Period

The span of time is called an elimination period. usually a policy with a longer elimination period charges lower premiums.

Medigap

Those eligible for Medicare who would like more coverage may buy Medigap (MedSup) insurance. You must have Medicare Part A and Medicare Part B to buy Medigap insurance. Medigap insurance supplements Medicare by filling the gap between Medicare payments and medical costs not covered by Medicare.

HMO basic health services includes inpatient, outpatient, maternity, mental health, substance abuse rehabilitation, and ______ care

emergency

In order to contain health care costs, physicians are encouraging consumers to pay with ____ for routine medical care and lab services

insurance