Choose a Healthcare Plan

Taylor Bohl, Mia Feldmann, Jaclyn Saltzman, Cara Venegoni

INDIVIDUAL HEALTH INSURANCE

• You get it when:

- the employer does not offer health plans

- you are self-employed

- you are unemployed

• Gives more flexibility, you can choose the coverage that works best for you from any insurance company

• It is generally more expensive than group policies

• Consider higher deductibles or high co-payments to keep premiums down

• Most colleges require students to be insured

• You can purchase student insurance, a basic policy, for a low price through the school

• Offers are often extended to recent graduates as well

GOVERNMENT- SPONSORED HEALTH INSURANCE

• Federal and State governments establish programs that provide health insurance for certain qualifying groups of Americans

MEDICARE

• Designed to provide low cost medical insurance for older Americans

• To qualify, must be 65 or older and have certain disabilities

• During working years, you contribute to the Medicare plan automatically by payroll deduction and employer matches contributions

• The payroll taxes help pay for the current Medicare recipients.

• Recipients pay a portion as well

• When you reach the federal retirement age, 65, the contributions of younger works and their employers will help support your Medicare costs

MEDIGAP

• Used to fill some of the gaps in Medicare coverage

• A supplemental insurance

• Sold by private insurance companies, not the government

MEDICAID

• Americans with low incomes or disabilities, regardless of age, may qualify.

• Helps insure the people without the means to pay for health insurance can receive health insurance

• Supported by both federal and state governments, run by states

• People who qualify for welfare assistance probably qualify for free treatment through this program

• Coverage varies state to state

• All are based on federal guidelines

WORKER’S COMPENSATION

• A state required insurance program where employers contribute to pay for work related injuries, illnesses or death

• Injured workers generally receive 2/3s of their salary while disabled.

• Incase of work-related death, the program provides cash benefits to the family

• Run by the States so coverage varies state to state

• Even if you have other health insurance, you will be covered for work-related claims by worker’s compensation if you are employed.

HOW TO SHOP FOR HEALTH INSURANCE

• Compare carefully

• Read policies, not just brochures

• Ask your insurance agent, or your company’s benefit coordinator what each plan covers

• Health insurance is only as good as the company that provides it

• Objective in buying any insurance is not to cover every possible expense but to protect yourself from expenses that are too high for you to pay on your own

• Health insurance is a trade off

• The greater the coverage the higher the premiums

• Decide what is most important to you

QUESTIONS TO ASK:

• do you need coverage for your family, or just yourself?

• Are there any major life cycle changes in the near future?

• Do you need coverage for any chronic illness or disabilities?

• Would you prefer to pay for preventive care and check ups or pay a higher premium for this care?

• How much can you afford?

• Is your doctor in the plan?

• How comfortable are you with having a limited selection of health care providers?

INSURANCE PROVIDER CONCERNS

• Physical Exams• Care by Specialist• Hospitalization• Vision• Rehab• Plans limits and

exclusions• Policy for going

outside the plan for care

• Prevented care• Prescription drugs• Dental• Physical Therapy• Number of doctors

and specialists participating in the plan

• Emergency procedures

GROUP HEALTH INSURANCE

• Large employers unions and professional organizations often offer group plans to members or employees

• Companies sometimes pay part or all of the premium as a benefit

• Premiums are lower for group insurance and the plans are less expensive

EMPLOYER SPONSORED PLANS

• During special period of the year, open enrollment, you can enroll in employer’s plan

• Part time workers usually do not get health insurance

COBRA

• Consolidated Omnibus Budget Reconciliation Act

• COBRA requires the employers to offer to continue health insurance for 18 months after a job is left.

• Must notify employer within 60 days of leaving, if you do this must pay the entire premium

PRE EXISTING CONDITIONS

• Medical Condition diagnose or treated before you join a new plan

• Your new insurance may not cover the expenses for that condition until waiting for a period of a month or more, no more that 12 months, in 12 months the plan must cover it.