Date post: | 27-Mar-2015 |
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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.