Affordable Care Act
Federal Act that made healthcare more affordable
Provided more healthcare to those with well below the poverty level
Mandated that all individuals needed insurance
Types of Private Insurance
Insurance an individual can sign up for and pay for on their own or as a benefit of employment.
Blue Cross
Harvard Pilgrim
Fallon Health
Public Health Insurance
Insurance that is paid for or subsidized by Federal and/or State governments.
Ex. medicare and medicaidPoint of Service
Premium
the monthly fee for your health insurance
Fees vary for individual, family or couple plans
3 Factors that Insurance premiums are based off of
age
location
smoking habits
deductible
the amount the insured must pay before insurance kicks in to cover costs
Co-inurance
the percentage of cost that the insured must pay for services
Out of Pocket Maximum
The total amount insured would have to pay in a year before the insurance will pay for everything else.
Actuarial Value
The percentage of costs that the insurance plan pay for for medical expences
Metals
the varying types of levels within an insurance company
Fees for premium and co-insurance vary
Platinum is most expensive premium with lowest co-insurance
Bronze has cheapest premium but higher co-insurance and deductibles
Catastrophic Plan
insurance plan for individuals that are under 30
Very low premium, high deductible
For mostly emergencies, some cover preventative care
HMO
Health Maintenance Organization'
Must have Primary Care Physician
Must see in-network doctors
Need referrals for specialists
EPO
Exclusive Provider Organization
Hybrid between HMO and PPO
Can see out of network doctors without referral but will have to pay own expenses
PPO
Preferred Provider Network
Do not need primary care or referrals to see specialist
Can see out of network doctors and only have to pay a portion of the expense
POS
Point of Service
Need a Primary Care
Need referral but can see doctors outside of network and insurance will pay some of the fees
Medicare
Public Insurance paid for by Federal Government
For individuals 65 and over, or who have a disability or kidney failure
Different types plans A, B, etc cover different expenses
Medicaid
insurance that is funded by Federal and state funds
State has say on coverage
Covers low income, children, disabled and blind
CHIP
Children's Health Insurance Program
Covers children whose parents do not make enough to afford private insurance but are not eligible for medicaid.
Veteran's Health Benefits
For veteran's that have medical conditions related to their time of service
Tricare
Federal insurance for all active and retired military and their families
Worker's Compensation
Insurance for those who are injured on the job
Covered by state and employer
Pays for lost wages and medical expenses due to injury on the job