HEALTH INSURANCEHow does health insurance work in the US?

What is insurance?

Health Care Insurance In the US?Part socialized (the government collects taxes and provides insurance )• Medicare (seniors)• Medicaid (very poor)• CHIP (for children in low

income homes)• VA hospitals (for veterans)• Public Hospitals (County)

Part privatized (you buy insurance policy from company)• Buy policy through/with your

employer• Humana, BCBS, Aetna, United

Health, etc.

Health Insurance• Most seniors get theirs from MEDICARE• The poor may qualify for MEDICAID or CHIP• Most must get their health insurance through their employer

Health Insurance Vocabulary• Premiums: monthly dues, paid by employee and/or employer• Copay: flat fee the patient pays to see a doctor• Deductible: what you must pay in a year before co-insurance• Co-insurance: percent breakdown for bills. 80% paid by Insurance, 20%

paid by you.• Out-of-pocket maximum: how much you must have paid in a year to be

eligible for 100% coverage• Annual Maximum: total amount that insurance will pay in a year for your

care• Lifetime maximum: total amount that insurance will pay in a lifetime for

your health care.

Review before activity• vocabulary practice

Explore an insurance policy• Using 2 handouts

Problems with health care that Affordable Care Act (Obamacare) seeks to reform• Uninsured (don’t qualify for assistance, can’t get insurance through

employment)• Some underinsured• Hospitals/taxpayers foot bill for uninsured, raising costs overall• Medicare is huge entitlement cost• Pre-existing conditions not covered • Coverage for older kids• Insurance companies have annual and lifetime maximums, so bills

can pile up without the help of insurance

ACA: 3 pronged approach to get people insured

1. Expand Medicaid so more low income people can qualify, improve Medicare

2. Open Marketplace so people can buy policy (on their own, without employer).

• Tax penalty for not having insurance• Provide affordable options

3. Improve policies1. Some preventative care covered 100%2. No annual/lifetime maximums3. Can’t be denied coverage for a pre-existing condition4. Kids up to 26 years can stay on parent’s policy

Medicaid• Will states expand

medicaid to receive federal $ • medicaid

expansion explained by kff• filling the gap

Practice as a class• Fill out together• Discuss

Summary• Think about what you have learned• Answer the question of the day focusing on what you have learned

Repeat on your own with another policy• Which policy suits you?

Obamacare• Get people insured that weren’t previously with a 3 pronged

approach1. Expand Medicaid so more low income people can qualify2. Regulate insurance industry more3. Open Marketplace so people can buy policy.

• Tax penalty for not having insurance• Provide affordable options

Obamacare: improve existing insurance• Healthcare is a right, so you have rights

• Bill of rights• Consumer protections• SBC’s• Pre-existing conditions for children not denied• Reducing insurance cancellations

• Insurance Choices – freedom, capitalism• Insurance Costs

• eliminate annual and lifetime limits• Premium $ health care costs (not overhead)

• Strengthen Medicare, eliminate gaps in coverage, reduce fraud, waste and abuse• Employers – small business tax credit

K-W-L• Jot down what you already know about insurance (any kind)

• What do you want to know?