Week 10 - Health Insurance Literacy
Is medicare free?
NO!
Describe individually purchased health insurance plans
-Directly from insurance company -eHealth -Insurance agents or brokers -Purchased through a government (ACA) Health Insurance Marketplace or Exchange ----Health insurance marketplaces (or exchanges) are online price comparison websites where consumers can shop for, purchase, enroll, apply for and receive federal subsidies, and be granted exemptions.
Reasons why people remain uninsured?
-High cost of insurance -Ineligible for work-sponsored insurance -Ineligible for government programs (undocumented, live in state that did not expand Medicaid) -Poor health insurance literacy
Describe the Veterans Health Administration
-Many but not all veterans are eligible for VA health benefits -Health benefits can vary significantly and are based on a priority system which considers military service, disability rating, income level, and other criteria. -Care for some is free; for others there are copays -Care provided at VA medical centers and outpatient clinics. Some care is provided by community health care providers under limited conditions. -Serves about 9 million Veterans a year -The VA defines a veteran as one who served in active military service and has been discharged or relieved under conditions other than dishonorable. -The number of veterans who can be enrolled in the VA Healthcare program is determined by how much money congress sets aside for it each year. . -Also, the type of benefits and services are based on a vets Priority Group. There are 8 priority groups. Vets in Group I are those with at 50% service connected disability. -You can find definitions of each priority group online at vets.gov or military.com. -There are some honorable discharged veterans who are not at all eligible for VA services due to their priority status and higher income. -The ACA did not change VA health care benefits or Veterans out-of-pocket costs (US Department of Veterans Affairs. (n.d.) VA, Affordable Care Act and You.
What are Parts A, B, D, and Supplemental Policies of Medicare?
-Medicare A (hospital insurance) -Medicare B (medical insurance) -Medicare D (optional; offered by private insurance; covers prescription drugs -Supplemental (Medigap) policies which pay for deductibles, services and copays not
Consequences of poor health insurance literacy?
-being uninsured or underinsured -making poor insurance decisions -inefficient use of insurance -limited access to care d/t high out of pocket costs -high medical bills and debt -poor health outcomes
Essential services all plan must cover? (dont have to memorize)
-mental health and substance abuse tx -maternity and newborn care -hospitalizations -outpatient care -lab services -emergency care -rx drugs -rehab -peds care -preventative services
What are factors that CAN affect a plan's monthly premium?
-where someone lives -age -tobacco use -plan category -whether plan covers dependents
Name some community resources for the care of the uninsured
1. Emergency rooms 2. Federally Qualified Health Centers -Community health centers, rural health clinics, migrant health centers, heath care for homeless 3. Free clinics (Clinica Amistad) 4. Pima County Health Dept -Family planning clinic -Vaccines for children program 5. Pima Community Access Program
2 kinds of private sources of health insurance?
1. Group (usually employer-based health insurance) 2. Individually purchased health insurance plans
5 types of government sources of health care?
1. Medicare 2. Medicaid 3. Children's Health Insurance Program (CHIP) 4. ACA Subsidies 5. Government as an employer -Tricare)
3 populations Medicare is for?
1. People who are 65 and older 2. Certain younger people with disabilities 3. People with End-Stage Renal Disease requiring dialysis or transplant
5 types of private insurance plans?
1. Preferred provider organizations (PPO) 2. Health maintenance organizations (HMO) 3. Point of services (POS) 4. Exclusive provider organizations (EPO) 5. High Deductible Health Plans (HDHP) -Health Savings Account (HSA)
7 ACA select provisions affecting people with private insurance?
1. Requires individuals to have insurance, with some exceptions (individual mandate) 2. Plans must cover young adults on parents policies until 26 y/o 3. Pre-existing conditions, one's health, medical history, and gender cant effect premiums -health insurance companies cannot discriminate based on these things! 4. ends lifetime and yearly dollar limits on coverage of essential health benefits 5. mandates essential health benefits that all plans must cover 6. No copays or coinsurance for certain preventative services 7. Insurers can no longer cancel health insurance
2 governmental alternatives to health insurance?
1. Veteran's Health Care System 2. Indian Health Service
2 sources that pay for health insurance?
1. private sources 2. government sources
What is health insurance?
A contract that requires a health insurer to pay some or all of an individual's health care costs in exchange for a premium. -A health insurance contract may also be called a policy or plan -A contract between a health insurer and an individual whereby an individual and/or an organization (such as an employer or the government) pays a premium and the insurer covers some or all of the individuals health care costs -That's how we fund our predominately for profit health care in the US. 91.2% of US population had health insurance for at least part of 2017
Describe the Indian Health Service
A health care system for members of one of the 573 federally recognized American Indian and Alaska Native tribes in the United States. Consists of 26 hospitals, 59 health centers, 32 health stations, and 33 urban health projects. Most personal and public health care is provided directly by IHS staff at their facilities. Some care can be provided by tribal facilities contracted by IHS, and very occasionally by non-native contracted health services · Provides care for approximately 2.2 million American Indians and Alaskan Natives. · IHS is a health care system, not a health insurance system, an entitlement program, or an established benefits package. IHS is an agency within the US DHHS. Has facilities in 37 states
What is the Medicaid program in AZ called?
Arizona Health Care Cost Containment System (AHCCCS or ACC)
What is the Affordable Care Act (ACA)? -4 goals?
Comprehensive health care reform law -AKA Obamacare or Patient Protection and Affordable Care Act -Goals: 1. inc access to health insurance 2. inc consumer protections 3. emphasize prevention and wellness 4. reduce health care costs -impacts both private and government insurance
What is an HMO?
Cover only care provided by doctors and hospitals inside the HMO's network -members often need to sign up with a PCP and that provider becomes the gatekeeper -often require members to get a referral from their PCP for other services and specialists -LEAST EXPENSIVE BUT MOST RESTRICTIVE
Describe group health insurance
Employer/employee share costs -155 million people (most people get health insurance through employer, but not all workers have access to health insurance) ---independent contracted workers; freelancer, consultants and other workers self-employed; employees of small businesses (under 50 people); dependents of workers; part-time workers, restaurant workers
Describe Healthcare Cost Sharing Ministries
Faith-based org that facilitates sharing of health care costs among members -members pay their fair share each month -usually self-pay for health care; plans then reimburse members after the fact -open to members who must follow practices of their community -used to replace health insurance or medicare -exempted from most ACA regulations (exempted from indiv mandate, may deny enrollment based on health status and preexisting conditions) -no guarantees for reimbursement -Medi-Share -6 companies
Most common private insurance plans? (2)
HMO's and PPO's
One private alternative to health insurance?
Health Care Cost Sharing Ministries
Describe Children's Health Insurance Program (CHIP)
Health insurance for low income children whose family has income above the cut-off for Medicaid eligibility -administered by state, based on federal guidelines -funded by state and feds -benefits vary from state to state -called KidsCare in AZ
What is Tricare?
Health insurance program for active duty and retired uniformed service members and their families (similar to private employer insurance) -AKA CHAMPUS -Care provided at military treatment facilities or by private health care providers, depending on the plan
What race is health literacy the highest in? the lowest?
Highest: non-hispanic whites Lowest: hispanics
What is Medicaid?
Joint federal and state health insurance program for people with low income (feds match state spending) -covers medicare premiums and copays for low income older adults -eligibility and covered services vary from state to state!
What is the ACA Subsidies?
Key provision of the ACA -provides gov subsidies to reduce monthly premiums and out of pocket costs (tax credits) -for people with low to moderate income who purchase their own health insurance (must be purchased through a government-sponsored health insurance marketplace) -does not impact people on medicare of those with employee sponsored health insurance -offers ppl w low to moderate incomes discounts (tax credits) on health insurance
Con's of HCCSM's?
No consumer protections of ACA -not regulated by state -may exclude for preexisting conditions or health status -no guarantee of payment/recourse for consumers -may not cover essential services -limited to health probs that don't conflict with Christian values
What is the individual mandate?
Original law included a tax penalty for those who did not have health insurance, but congress passed a tax law in 2017 eliminating the penalty -mandate remains, but no consequences for not following the law -very controversial
What is an HDHP?
Premiums significantly lower than others, but there are much higher out of pocket costs! (many have deductibles over $3000) -Grown in popularity over last 5 years as insurance costs have skyrocketed
Health literacy and the subcategory of health insurance literacy are ______ in the US
SDOH
Describe risk factors associated with poor health insurance literacy
Similar to those with poor general health literacy! -Racial and ethnic minorities (esp low income - HISPANICS) -Unstable housing -Access to phones and the Internet -Limited Experience with making decisions about health care -Limited understanding of terminology used -Limited in-person support (everything was either online or over the phone -Too much information to process -Information was too complicated; or presented unclearly -Low health literacy -Low financial/math literacy -Limited eLiteracy -LACK OF PREVIOUS HEALTH INSURANCE COVERAGE
What are health savings accounts?
Special accounts that may be offered with HDHP -people have money deducted from their paychecks into an account which can be used to pay for out of pocket medical and dental bills
What is health insurance literacy?
The capacity to find and evaluate info about a health insurance plan, select the best plan given financial and health circumstances, and use the plan once enrolled
What are PPO's?
Usually have higher premiums and deductibles, but offer greater flexibility -less costly to using preferred providers, but can use out of network providers -don't need referrals!
What is a POS?
covers providers out of network, but at an increased cost
What did the ACA do for Medicaid?
gave states money to expand Medicaid through increased eligibility
What is and EPO?
limites providers to those in network
The ACA made multiple provisions of the Medicare program. What is one of these?
preventative benefits
Pro of HCCSM's?
usually lower out of pocket costs
