CH 11 - Planning for Health Care
Expenses Questions Answers
What are the 3 finance related expenses of health care? - ANSWERS1. direct medical
care cost
2. long-term care
3. lost income when you cannot work due to illness or injury
Health insurance - ANSWERSinsurance against the risk of incurring medical expenses
among individuals
Affordable Care Act - ANSWERSdesigned to address health care issues in USA by
requiring all persons have a health care plan
- it was a policy that became a law. It is know an exchange program in which people
can buy insurance through
What is the goal of the ACA? - ANSWERSTry to get younger people or those who don't
have coverage to buy insurance, even if they don't need it
- this allows those who need more coverage (older people or sick) to have sufficient
funds for insurance
- the ACA allows funds to be built up from those who might not need it for those who do
need it
Who does the ACA impact? Who doesn't the ACA impact? - ANSWERS- It impacted
people who didn't have insurance; know they have to buy insurance
- it didn't impact people who had insurance. Their private insurance fulfills the law
quality health care plan - ANSWERSan ACA provision that requires all health care
policies meet the government's standard for its required "10 essential benefits" of
adequate coverage
individual mandate - ANSWERSAn ACA provision that require all Americans and legal
residents buy health coverage no matter how sick and regardless of any pre-existing
health problems
- encourages all Americans to buy insurance to help provide coverage for cost of all
community
individual shared responsibility fee - ANSWERSA tax penalty of the Affordable Care Act
that is assessed when one does not buy health insurance.
What are the 10 essential benefits that are required for a quality healthcare plan? -
ANSWERS1. ambulatory services (outpatient and doctor's visits)
2. emergency services
, 3. hospitalization
4. maternity and newborn care
5. mental health and substance use services
6. prescription drugs
7. rehabilitative services and drugs
8. laboratory services
9. preventive and wellness services
10. pediatric services
Provisions under the ACA - ANSWERS1. no cancellations of policies or denial of
coverage for preexisting conditions
2. men and women are charged the same rate
3. free preventative care and annual checkups
4. no limits on maximum payments
5. children remain on plan until age 26
6. no need for a referral when choosing a provider
what is the purpose of preventative care? - ANSWERS- check for conditions before
large diseases begin
- prevents insurance from paying larger claims in the future
preexisting conditions - ANSWERSa health problem that a person had before being
covered by the insurance
health insurance exchanges - ANSWERSstate-by-state mechanisms established by the
ACA through which consumers can purchase a health care plan
- how those who don't have insurance before the ACA can receive it
- insurance companies compete to sell you their policies
Out-of-pocket maximum - ANSWERSThe most you pay during a policy period before
your health insurance or plan begins to pay 100 percent of the allowed amount.
- pay deductible, copay, and coinsurance (80/20), up to a certain amount before
insurance company pays for 100% of medical expenses
-tells you how much you have to pay out of your pocket before insurance covers
everything
-insurers are willing to take this risk because people don't often meet their out of pocket
maximum
Summarize how subsidies reduce the price of insurance premiums under the ACA. -
ANSWERS-ACA subsidizes the low and middle income people, which allow them to
purchase insurance at a discounted rate
-premiums are determined by supply, demand, and geographic location
healthcare subsidy - ANSWERSForm of financial assistance from the government that
helps reduce health care costs
Expenses Questions Answers
What are the 3 finance related expenses of health care? - ANSWERS1. direct medical
care cost
2. long-term care
3. lost income when you cannot work due to illness or injury
Health insurance - ANSWERSinsurance against the risk of incurring medical expenses
among individuals
Affordable Care Act - ANSWERSdesigned to address health care issues in USA by
requiring all persons have a health care plan
- it was a policy that became a law. It is know an exchange program in which people
can buy insurance through
What is the goal of the ACA? - ANSWERSTry to get younger people or those who don't
have coverage to buy insurance, even if they don't need it
- this allows those who need more coverage (older people or sick) to have sufficient
funds for insurance
- the ACA allows funds to be built up from those who might not need it for those who do
need it
Who does the ACA impact? Who doesn't the ACA impact? - ANSWERS- It impacted
people who didn't have insurance; know they have to buy insurance
- it didn't impact people who had insurance. Their private insurance fulfills the law
quality health care plan - ANSWERSan ACA provision that requires all health care
policies meet the government's standard for its required "10 essential benefits" of
adequate coverage
individual mandate - ANSWERSAn ACA provision that require all Americans and legal
residents buy health coverage no matter how sick and regardless of any pre-existing
health problems
- encourages all Americans to buy insurance to help provide coverage for cost of all
community
individual shared responsibility fee - ANSWERSA tax penalty of the Affordable Care Act
that is assessed when one does not buy health insurance.
What are the 10 essential benefits that are required for a quality healthcare plan? -
ANSWERS1. ambulatory services (outpatient and doctor's visits)
2. emergency services
, 3. hospitalization
4. maternity and newborn care
5. mental health and substance use services
6. prescription drugs
7. rehabilitative services and drugs
8. laboratory services
9. preventive and wellness services
10. pediatric services
Provisions under the ACA - ANSWERS1. no cancellations of policies or denial of
coverage for preexisting conditions
2. men and women are charged the same rate
3. free preventative care and annual checkups
4. no limits on maximum payments
5. children remain on plan until age 26
6. no need for a referral when choosing a provider
what is the purpose of preventative care? - ANSWERS- check for conditions before
large diseases begin
- prevents insurance from paying larger claims in the future
preexisting conditions - ANSWERSa health problem that a person had before being
covered by the insurance
health insurance exchanges - ANSWERSstate-by-state mechanisms established by the
ACA through which consumers can purchase a health care plan
- how those who don't have insurance before the ACA can receive it
- insurance companies compete to sell you their policies
Out-of-pocket maximum - ANSWERSThe most you pay during a policy period before
your health insurance or plan begins to pay 100 percent of the allowed amount.
- pay deductible, copay, and coinsurance (80/20), up to a certain amount before
insurance company pays for 100% of medical expenses
-tells you how much you have to pay out of your pocket before insurance covers
everything
-insurers are willing to take this risk because people don't often meet their out of pocket
maximum
Summarize how subsidies reduce the price of insurance premiums under the ACA. -
ANSWERS-ACA subsidizes the low and middle income people, which allow them to
purchase insurance at a discounted rate
-premiums are determined by supply, demand, and geographic location
healthcare subsidy - ANSWERSForm of financial assistance from the government that
helps reduce health care costs
