What do you think is the average cost for the following… Emergency room visit $1,318 Ambulance ride $1,099 Broken arm (non-surgical treatment) $2,500 Having a baby at a hospital $13,000!

Health Insurance

Kinds of Coverage Medical Dental Vision (hospital visits, normal doctor visits, etc) Dental Vision

Terminology Deductible Co-Payment (Co-Pay) Out-of-pocket maximum Expenses add up through the year to meet your deductible Not paid for every injury EX: If my deductible is $500 and I have 3 hospital visits that cost $500 total, my next hospital visit will be covered by insurance Co-Payment (Co-Pay) The amount you pay up front for each time you receive medical services Counts toward the total medical bill Does not count toward your deductible Out-of-pocket maximum The maximum amount you are required to pay in health expenses in one year Insurance company pays 100% of all costs after that

Terminology In-Network provider Out-of-network provider A doctor who is in your health plan’s preferred (discounted) group Cheaper Out-of-network provider A doctor who is NOT in your health plan’s preferred (discounted group) More expensive Many terms we discussed in our first section of notes (How Insurance works) also apply to health insurance Co-insurance Premiums

Types of Insurance Plans PPO HMO “Preferred Provider Organization” Provides a larger selection of “in-network” doctors than an HMO plan Costs more than an HMO “Health Maintenance Organization” Smaller choice of “in-network” doctors than PPO Costs less than a PPO

Government Health Insurance Plans Medicare Health insurance for elderly people Medicaid Health insurance for low-income families

Changes with Obamacare No lifetime caps Can’t be denied due to a pre-existing condition Stay on your parents insurance until you are 26 Free birth control (unless you work for a faith-based organization) Almost everyone is required to have health insurance Penalties are assessed if you don’t

Quick Review What is the limit called where after you’ve paid a certain amount, you no longer have to pay any more for medical expenses? What is it called when you have to pay a small amount every time you visit the doctor? Between in-network and out-of-network, which doctors are cheaper to visit? Which of the different types of health insurance plans tends to be the most expensive, but also offers the largest selection of in-network doctors? Out-of-pocket maximum Co-pay In-network PPO

Nicki’s Story…. Nicki was dared to off the roof of her house into a pool. With an immense amount of peer pressure and her friend at her side, this happened…..

Nikki’s Story Nikki was taken to the hospital where she was told she had a broken ankle. The cost to pay her broken ankle was $1,000 How much of this $1,000 would Nikki need to pay out of her own pocket? It depends……

Nikki’s Story How much would she need to pay if she’s already reached her out-of-pocket maximum? NOTHING! Assuming she hasn’t reached her out-of-pocket maximum, what is the first thing Nikki would need to pay while she was in the hospital? Co-Payment How much of the $1,000 would she need to pay if she hasn’t reached her deductible of $2,500? ALL OF IT!

Nikki’s Story Assuming Nikki HAS reached her deductible amount of $2,500 and that her health insurance has 50/50 co-insurance coverage, how much of the $1,000 would she need to pay? $500