Focus on Personal Finance: Chapter Nine 2024 SOLUTION GRADE A+ GUARANTEED

health insurance - eases the financial burden people may experience as a result of illness or injury - includes meducal expense insurance, and disability income insurance group plans - covers most individuals - usually employer-sponsored - employer pays part or most of cost the health insurance portability and accountability act of 1996 (HIPAA) - federal portability standards - if you change jobs you need not lose your health insurance group policy supplements coordination of benefits = benefits received from all sources limited to 100% of allowable medical expenses individual health insurance coverage that is purchased on an individual or family basis, as opposed to being offered by an employer COBRA requires many employers to offer employees and dependents the option to continue their group coverage for a set period of time following a layoff types of health insurance coverage - basic - major medical - both basic health insurance - hospital expense insurance (e.g. hospital room, board, and other charges) - surgical expense insurance (surgeon's fee for an operation) - psysician expense insurance (pays for psysician's care that does not include surgery, such as office visits, lab tests, and x-rays major medical expense insurance - covers expenses for a serious injury or long-term illness - may include a deductible, coinsurance, and a stop-loss provision comprehensive major medical insurance - low deductible offered without a separate, basic plan - covers hospital, surgical, and other bills hospital indemnity - pays you for a fixed amount for each day you are hospitalized - does not cover medical costs - supplement to the other plans dental expense insurance covers exams, cleaning, x-rays, fillings, root canals, and oral surgery vision care exams, contact lenses, and glasses dread disease policies - pays out for very specific conditions - illegal in many states - AFLAC Cancer Coverage long-term care insurance - makes sense for those with net worth of $100,000 to $2 million - covers daily help if seriously ill or disabled - nursing home or in-home care eligibility for health insurance policies varies with age, marital status, and dependency assigned benefits insurance pays your doctor or hospital directly internal limits fixed amount per day for a hospital room copayment cost-sharing in the form of a flat dollar amount you pay, such as $15.00 per office visit or $10 per prescription service benefits entitlement to specific services benefit limits maximum dollar amount of maximum number of days spent in the hospital exclusions and limitations to health insurance policies - pre-existing conditions - cosmetic surgery cancellation and termination of health insurance policies explains the circumstances under which policy can be canceled trade-offs in choosing a policy - reimbursement versus indemnity - internal limits versus aggregate limits - deductibles and coinsurance - out-of-pocket limit - benefits based on reasonable and customary charges reimbursement pays actual costs indemnity pays specific amounts a health insurance plan should: - offer basic coverage for hospital and doctor bills - provide at least 120 days hospital room and board in full - provide at least a $1 million maximum for each family member - pay at least 80% for out-of-hospital expenses after a yearly deductible of $500 per person or $1,000 per family - impose no unreasonable exclusions private health insurance companies - individual policy - group policy sold to employers hospital and medical service plans - blue cross = hospital care - blue shield = surgical and medical services health maitenance orginization (HMO) - managed care (prepaid health plan, primary care physician) - contracts with selected care providers - fixed pre-paid monthly premium - focus is on prevention and wellness - basic and supplemental services preferred provider orginization (PPO) - several providers to choose from - costs more than an HMO - more choices, fewer restrictions than an HMO - going to a non-PPO provider will cost you more point of service (POS) - combines features of HMOs and PPOs - hybrid or open-ended HMO home health care agencies medical care in a home setting for a fraction of the cost of hospitals employer self-funded health plans - company runs self-insured insurance program - collects premiums from employees - pays medical benefits as needed health spending accounts (HSA) money contributed to tax-free account health reimbursement accounts (HRA) - tied to high-deductible policies - funded solely by employer - unused funds carried over to next year flexible spending accounts (FSA) - pre-tax dollars - funds managed by employer - unused funds forfeited at year-end comparison of HSAs, FSAs, and HRAs (image) medicare - federally funded health insurance program - covers those age 65+ and certain disabled persons - does not cover everything - patient liable for difference the four parts of medicare part a: hospital insurance part b: medical insurance part c: medicare advantage plan pard d: prescribtion drug coverage medicare: part a hospital insurance helps pay for inpatient care in a hospital or skilled nursing facility; some health care and hospice care medicare: part b medical insurance helps pay for doctors' supplies not covered by hospital insurance medicare: part c - medicare advantage plans available in many areas - those with parts a and b can choose to receive all of their health care services through one of these provider orginizations under part c medicare: part d prescription drug coverage helps pay for medications doctors prescribe for treatment medicare choice - created by balanced budget act of 1997 - allows choice of a managed care plan in addition to medicare coverage medigap (medsup) - medicare supplement insurance policy - private coverage fills gaps in medicare parts a & b medicare plan comparison (image) medicaid - medical assistance offered to certain low-income individuals and families - administered by states CONTINUED......