The ABC’s of Health Insurance

The ABC’s of Health The ABC’s of Health InsuranceInsurance

Welcome, !Welcome, !August 2010August 2010

Presenter: Barbara Stark Presenter: Barbara Stark

From January to September 2009, 46.0 million persons of all ages were uninsured

46 Million is 16% of the population.

To get 46 million take all of Indiana; population 800,000; plus Texas, Florida, and Connecticut

From January to September 2009, Hispanic persons were considerably more likely than non-Hispanic white persons, non-Hispanic black persons, and non-Hispanic Asian persons to be uninsured at the time of interview.

Who are the uninsured?Who are the uninsured?

Objective Objective By the end of this presentation you will be able to:

Have a clear understanding about Health Insurance

Why it is important to have health insurance

Know the cost of being uninsured

Know where to find more information

8%

16%

13%

9%

15%

23%

36%

37%

35%

47%

Contacted by collectionagency about medical bills

Had problems payingmedical bills

Did not fill a prescriptionbecause of cost

Needed care but did notget it

Postponed seeking carebecause of cost

Uninsured

Insured

Percent Reporting Barriers to Health Percent Reporting Barriers to Health Care, 2003Care, 2003

Uninsured persons are less likely to seek Uninsured persons are less likely to seek preventive or necessary care….preventive or necessary care….

Average trip to the emergency room is almost $1,ooo$1,ooo

(Not including count tests and any other follow up needed)

• X-Rays $125-$150$125-$150• MRI’s will drive up your bill up by another $1,800$1,800• CT Scans Average $1,200$1,200• A broken leg will cost you approximately $7500$7500• Hip replacement go for almost $32,000$32,000• If your appendix ruptures, necessary surgery tops

$11,000$11,000

Hernia troubles can run you a bill of almost $6,200$6,200

Carpal Tunnel surgery averages $3,200$3,200Heart troubles requiring a stent or

angioplasty lead a bill of almost $26,000 $26,000Coronary bypass surgeries start at $57,ooo$57,oooA diagnosis of chest pain averages $6,000$6,000Childbirth costs range from $5,000 $5,000 to

$11,000 $11,000 depending on the procedure necessary

An average trip to your family doctor costs a little more than $50$50

If you're a new patient the more complex visit will cost around $150$150

Necessary test include Blood count $35$35Blood sugar $45$45Mammogram $105$105Strep throat $40$40Thyroid $65$65Urine test $20$20EKG $65$65

Deductible Co-pay Premium Pre-existing

condition Provider and

subscriberOut of pocket

expense

In-network provider vs. out-of-network provider

HMO PPOHealth Savings

Accounts

DeductibleDeductibleThe amount you pay before your insurance starts to

pay.

In general, the higher your deductible, the lower the

premium.

Co-PayCo-Pay A fixed amount the subscriber pays at the time of service

(when you go to the doctor).

The amount may differ depending on the type of doctor you visit (general practitioner vs. specialist)

There are co-pays for doctor’s as well as for prescription medications.

What is a Premium? What is a Premium?

Premium - the monthly fee that is paid to an insurance company or health plan to provide health coverage, including paying for health-related services such as doctor visits, hospitalizations, and medications

The insurance company

When you call a doctor to schedule an appointment the receptionist will ask, “Who is your health insurance provider” and you will respond “Blue

Cross/Blue Shield” or “United”

You- the insured.

SubscriberSubscriber

Out of Pocket ExpensesOut of Pocket ExpensesMedical costs which the subscriber (YOU) is

responsible for.

These are in addition to the cost of the premium. They are charges the insurance will

not cover (e.g., deductible, co-pays, etc)

A healthcare provider or facility that has a contract with the insurance company

They provide services at a reduced cost to subscribers of that insurance company

A healthcare provider or

facility that does not have a contract with the insurance

company.

Treatment at these facilities will cost the patient more

Out-of-NetworkOut-of-Network

Types of Health Insurance include:

Managed Care:

Preferred Provider Organizations (PPOs)

Health Maintenance Organizations (HMOs)

OthersHealth Savings Accounts

PPO- Preferred Provider OrganizationsPPO- Preferred Provider OrganizationsPatient may see any doctor on list of PCPs

(Primary Care Providers)Patient may visit specialist without referral

from the DoctorMay pay greater co-pay, deductible, and likely

more out-of-pocket expenses

HMO- Health Maintenance OrganizationHMO- Health Maintenance Organization You will be assigned a general practitioner (GP)

That GP will determine if and when and to whom you will go if more specialized treatment is necessary (serves as a

gatekeeper)

You may receive a list of PCPs (Primary Care Providers) from which to choose a doctor (based on location, gender, etc.)

Typically with the HMO, no deductible is charged

There may be a small co-pay fee for visiting a doctor in-network

Health Savings AccountsHealth Savings Accounts HSAs allow consumers to pay for qualified medical

expenses with pre-tax dollars—meaning income-tax free—and save for retirement on a tax-deferred basis.

An HSA is tax-favored savings account that is used in conjunction with a high-deductible HSA-compatible health insurance plan to make healthcare more affordable.

In order to have a Health Savings Account, you must get an HSA-compatible health insurance plan. This type of insurance plan is often referred to as a High Deductible Health Plan, and typically has lower premiums than plans with lower deductibles.

Emergency Rooms are NOT a good Emergency Rooms are NOT a good fallback planfallback plan. .

Health care is more expensive when Health care is more expensive when you’re uninsured.you’re uninsured.  

It’s the double-whammy of going without coverage.  Uninsured persons are usually charged full price for medical services,

because they don’t qualify for the discounts negotiated between medical providers and the insurance companies on behalf of members. 

You run the risk of making You run the risk of making yourselfyourself

According to a study released in 2009, over 55% of

personal bankruptcies in the United States are

related to overwhelming medical bills.

Medical bills are a leading Medical bills are a leading cause of personal bankruptcycause of personal bankruptcy

Medical debts can quickly cause financial crisis.

Many ignore their medical debt thinking it will just go away….BUT if you ignore your debt it can lead to:

Which can lead to:

If you ignore your medical debt you can even be taken from your weekly paycheck!

Being uninsured could ultimately lead to….

“9 years ago, I was in the hospital for a week; I had cat scans, iv drugs, the whole shebang. No insurance and about a $8,000 bill.

I thought I could get away with not paying it, and no one ever called me, or sent me collection notices or anything. Out of sight, out of mind, right?

6 years later I get served with a Garnishment Suit, and risked losing my job over it!!!!

I had no choice but to file Bankruptcy and now I am having to completely rebuild my financial life! Please don't make the same mistake!”

Truth is that despite the cost, health insurance protects you in case of serious illness or

accident.

18,000 excess deaths per year due to lack of health coverage

People without insurance:

Receive less care and receive it later Have 25% higher mortality rates

Receive poorer care when they are in hospitals

This is the fifth leading cause of death in the US

–RevolutionHealth.com provides information, inspiration and tools to help you take control of your health and improve your life www.revolutionhealth.comwww.revolutionhealth.com

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www.aflcio.orgwww.aflcio.org

www.infanthealthinsurance.orgwww.infanthealthinsurance.org

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