Health Insurance.pptx

Health Insurance The Basics © 2020 Business Boss. All Rights Reserved. What is health insurance? ▪Just like the other insurance policies we’ve discussed, health insurance is in place to protect yourself financially if you get sick or injured. Health insurance can also be used to prevent major sickne...

Health Insurance The Basics © 2020 Business Boss. All Rights Reserved. What is health insurance? ▪Just like the other insurance policies we’ve discussed, health insurance is in place to protect yourself financially if you get sick or injured. Health insurance can also be used to prevent major sickness or injuries. ▪For example: ▪ If you break your leg and have to go to the hospital, you can use your health insurance to help cover the hospital bills. ▪ Meanwhile, if you’re just going to visit your family doctor for a yearly health and wellness check up your insurance will help cover the doctor visit bills even though you’re not actually sick yet. Who can have health insurance? ▪ Health insurance is not mandatory by law. ▪ Many employers offer a health insurance policy for their employees, or you can go get a policy on you own. ▪ If your employer has 50+ full time employees, its required by law for them to offer a health insurance policy. ▪ It’s not required for them to pay for your policy. However, they will often pay for part or all of it. ▪ Just because an employer offers you an insurance plan doesn’t mean you have to take it. ▪ Policies can be for a single individual, a couple, or even a family. ▪ Generally, the more people on your plan, the more expensive the plan will be. ▪ However, some agencies offer family plans. Instead of charging per child, they will let you have multiple children on the policy for the same price. ▪ If your spouse has a job with a good health insurance policy, you can join their plan. Health Insurance Options ▪If you had insurance through your employer and you have to stop working, you may have COBRA continuation coverage ▪ COBRA is short for the Consolidated Omnibus Budget Reconciliation Act ▪ It gives people the right to continue coverage through a work-based group plan after a job loss, death of a spouse, divorce or loss of eligibility for dependent coverage. COBRA lasts as long as 18 months. ▪If you have low-income and can’t afford insurance, you can qualify for a government insurance plan. ▪ Medicaid is the state and federal insurance program for low-income individuals and families. ▪ Medicare is for people age 65 and older and for young people with certain disabilities. Do You Need Health Insurance ▪YES! ▪Everyone should have health insurance at all times. Going without insurance is very risky. If you don’t have health insurance and an unexpected event occurs (such as an accident, heart attack, or aneurism) you are responsible for the entire hospital bill. ▪A bill this large could lead you to a lifetime of debt or even bankruptcy. ▪If you’re considered a child, you can stay on your parents policy until you’re 26 years old. ▪If you’re considered a student, you can shop for discounts to help make your plan more affordable. Health Insurance Plan Options ▪Whether you’re shopping for insurance on your own or taking it from a job you have, you are going to have different options to pick from. ▪It’s important to look for an option that meets your needs. ▪ If you’re generally healthy with no known medical issues, you could save money and opt for a lower premium payment with a higher deductible and copay option. ▪ However, if you have a known health issue and know you’re going to need to visit a doctor and/or hospital frequently, you’ll want to search for a lower deductible. ▪When you have children, you’ll need to add the child to your plan. It’s not just assumed and children are not automatically covered. What’s covered with health insurance? ▪Health insurance doesn’t cover everything. ▪There are a few ways that health insurance companies might share costs with you: ▪Deductible ▪Copayment ▪Coinsurance ▪Out-of-pocket limit Picking A Plan For You ▪Premium: the monthly amount you pay to have health insurance. ▪ Normally, the lower your premium, the higher your out-of-pocket expenses will be. ▪Deductible: how much you need to pay for health care services out-of-pocket before your health insurance kicks in. ▪ In most plans, once you pay your deductible, you'll still need to pay copays and coinsurance until you hit the out-of-pocket max. ▪ At that point the plan pays for 100% of services. ▪Out-Of-Pocket: the total amount you’ll pay for care. ▪ This includes the deductible and your part of the medical bills. Picking A Plan For You ▪ Copayment: A fixed amount that you pay for a specific service or prescription medication. ▪ Copayments are one of the ways that health insurers will split costs with you after you hit your deductible. ▪ You may also have copayments on specific services before you reach your deductible. ▪ For example, many health insurance plans will have copayments for doctor’s visits and prescription drugs before you hit your deductible. You will pay copayments until you hit your maximum out-of-pocket amount. ▪ Coinsurance: a percentage of the cost that you pay for covered services. ▪ If you have a coinsurance of 20%, you’ll pay 20% of the cost of covered services until you reach your out-of-pocket maximum. ▪ Maximum Out–Of-Pocket: The most you’d ever have to pay for covered health care services in a year. ▪ Payments made towards your deductible, as well as any copayments and coinsurance payments, go toward your out-of-pocket limit. Monthly premiums do not count. Picking A Plan For You ▪Aside from the money, other factors should be taken into consideration when picking a plan as well. ▪Not all plans cover all doctors. Different doctors accept different insurances. If you’ve been visiting a doctor that you love, make sure you pick a health insurance plan that your doctor works with. Plan Factors ▪The maximum out-of-pocket limit for 2020 is $8,200 for individual plans and $16,400 for family plans. ▪Plans with higher premiums (amount paid each month) tend to have lower out-of-pocket limits (amount paid total). ▪Thanks to the Affordable Care Act, there are five factors that go into setting your health insurance premium: ▪ Age ▪ Location ▪ Tobacco use ▪ Individual plan vs family plan ▪ Plan category (how much you’ll pay vs the insurance company) Put It All Together On your note sheet, explain the bucket analogy with the three steps. Practice Game ▪ First, everyone is going to draw a card to see who their “family” is. ▪ You will either be an individual, a couple, or a family with kids. ▪ Once you draw your family, you’ll go meet with them somewhere in the room. ▪ Next, your family is going to draw a card to see what kind of insurance policy you have. ▪ Policies will have different premium, deductible, and out of pocket expense amounts ▪ Your policy will also tell you if you have any other supplemental insurance ▪ Then, each member in your family is going to draw two health emergencies. ▪ The emergency cards will tell you what happened, the medical costs for various insurance coverages, and how you had to get treated. ▪ Some cards have serious scenarios, others have check up items, and some have a free pass with no penalty. ▪ Finally, you’re going to analyze your health emergencies against your policy. You’ll see if your visits were covered by insurance and calculate your payments. Supplemental Insurance ▪Health insurance doesn’t always cover every aspect. This is where supplemental health insurance can be helpful. You can buy these policies in addition to your health insurance plan. ▪Examples of these extra policies can be: ▪Dental – relatively inexpensive to cover your dental checkups ▪Vision – normally inexpensive to cover routine eyewear and checkups ▪GAP – helps cover your out-of-pocket expenses ▪Critical Illness – helps pay for expensive illness such as Alzheimer's, cancer, and strokes ▪ If you’re diagnosed while you have this insurance policy, they’ll pay you a sum of money. Sources ▪ https://www.insure.com/health-insurance/basics.html ▪ https://www.policygenius.com/health-insurance/learn/health-insurance-basi cs-and-guide/