1. “There are worse things in life than death. Have you ever spent an evening with an insurance salesman?” -Woody Allen Copyright © eNestEgg Press, LLC.

2. Learning Objectives What is health insurance Why is health insurance important/ why do I need health insurance? How does health insurance work? Types of health insurance coverage Types of health care plans (private and government) Obama Care changes Keeping health care costs low/ getting the best deal Copyright © eNestEgg Press, LLC.

3. Staying Healthy is Expensive For 2012, the previous report, annual premiums for employer-sponsored family health coverage reached $15,745, up 4 percent from 2010, with workers on average paying $4,316 toward the cost of their coverage. Why is health care so expensive What can you do to reduce heath care expenses Copyright © eNestEgg Press, LLC.

4. What is Health Insurance? Health insurance- Insurance that covers the cost of an insured individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider. It may be the most important type of insurance you can own. Without proper health insurance, an illness or accident can wipe you out financially and put you and your family in debt for years. Health insurance Copyright © eNestEgg Press, LLC.

5. Why is health insurance important? It’s easy to underestimate how much medical care can cost: Fixing a broken leg can cost up to $7,500. The average cost of a 3-day hospital stay is around $30,000. Comprehensive cancer care can cost hundreds of thousands of dollars. Estimated cost calculator Medical Insurance protects you and your family from getting crushed by very expensive and unexpected health expenses. Importance of health insurance Costs of not having insurance Benefits of health insurance Copyright © eNestEgg Press, LLC.

6. How does health insurance work? There are still deductibles and premiums: Deductible- The amount you must pay out of pocket before your insurance kicks in. Ex. Mary has a $1000 deductible. Once her yearly health expenses are greater than $1000 her insurance company start footing the bill (or part of the bill). Premium- The amount you pay for your insurance. Remember, choosing a higher deductible means lower premiums. Copay- This is an amount you will pay every time you use medical services. Ex. Mary went to the doctor for the flu. She has reached her deductible for the year but still must $20 for visiting the physician. That $20 is her copay. Copyright © eNestEgg Press, LLC.

7. How does health insurance work? Coinsurance- What percentage each part pays for medical services. Ex. Mary has passed her deductible for the year by $1000. Her coinsurance with her insurance company states that Mary will pay 20% for medical services, while the insurance company will foot the other 80%. She will have to pay $200 out of pocket. Your maximum (out of pocket limits, stop loss, etc.)- A limit on the amount you must pay for that period. Ex. Mary was always sick this year. Her medical bills were $150,000 for this period. Her plan has an out of pocket limit of $100,000. Any amount of medical expenses incurred after this period are 100% paid by her insurance company. Having out of pocket limits often increases your deductible. How Health insurance works The Basics Explained Copyright © eNestEgg Press, LLC.

8. Question Cluster 1 Copyright © eNestEgg Press, LLC.

9. Types of Coverage Basic coverage Meets the needs of most policyholders. It includes: Hospital expense coverage Surgical expense coverage Physician Expense coverage Major Medical Major medical coverage- Also known as an High Deductible Health Plan or (HDHP). Covers expenses associated with a serious illness or hospitalization. Often have high deductibles. Copyright © eNestEgg Press, LLC.

10. Types of Plans- Private Private plans are provided by private insurance companies and many other organizations. Private plans insure the majority of citizens. Private plans come in many different flavors including: HMOs PPOs Indemnity Plan POS And more Copyright © eNestEgg Press, LLC.

11. Indemnity vs Managed Care Indemnity insurance- also called "fee-for-service" generally gives you greater freedom and flexibility than managed care. However, you'll pay more out of pocket for the health care you get. With indemnity coverage, you can choose any doctor, hospital, laboratory, or other medical provider. Managed care insurance- Flips indemnity coverage 180 degrees. With a health maintenance organization (HMO), deductibles are often smaller than with other plans and sometimes there are none. Co-payments are fixed and low, and preventive care, drugs, and mental health treatment are usually covered. Managed Care insurance Indemnity vs. Managed care Copyright © eNestEgg Press, LLC.

12. HMOs Health Maintenance Organizations (HMOs): Type of managed care plan An organization of hospitals and providers that provide health care to its members. Charges a fixed prepaid monthly premium. HMO often include co-pay agreements. HMOs are big on preventative care. Savings from HMOs are often balanced out by the restrictiveness of the organizations. Any services used outside your network of providers is generally not covered. If you have developed a good working relationship with your current physician an HMO may prevent you from seeing them. Advantages & Disadvantages About HMOs Copyright © eNestEgg Press, LLC.

13. PPOs Preferred Provider Organization (HMO) Type of managed care plan A variation of an HMO. Much like HMOs, PPOs have a group of providers and facilities that agree to provide medical treatment for predetermined fees. PPO premiums tend to be higher than those of an HMO. The advantage of a PPO is they are more flexible than HMOs. With a PPO you can receive treatment from outside your network. This comes with deductibles and copayments, however. Payments for PPO care are generally fee-for-service. About PPOs Differences Copyright © eNestEgg Press, LLC.

14. POS Point of Service (POS) plans- Combine features of both HMOs and PPOs. If you receive care from a plan provider, you pay little or nothing. You are also allowed to seek care outside your network for a greater charge. The difference between HMOs, PPOs, and POS is not always clear and in many ways the plans are becoming more similar. About POS Copyright © eNestEgg Press, LLC.

15. Question Cluster 2 Copyright © eNestEgg Press, LLC.

16. Government Plans The federal and state Government offer many different health insurance programs to their citizens. Eligibility for these programs is based on both age and need. Programs include: Medicare Medigap Medicaid Copyright © eNestEgg Press, LLC.

17. Medicare Medicare- Is available beginning at age 65. It is also open to certain citizens below the age of 65 with disabilities. Over 50 million Americans are covered by Medicare. Medicare doesn’t cover everything. Certain types of care (Dental, long term, certain prescriptions, etc.) are not covered at all. Many Physicians do not accept Medicare. Supplemental insurance is often needed. Copyright © eNestEgg Press, LLC.

18. Medicaid Medigap- A type of Medicare supplemental insurance Policy that is separate from Medicare which covers the areas Medicare does not. Purchased from a private insurance company. Medicaid- Government health program for low income citizens. You can qualify for Medicaid at any age. Medicaid coverage tends to be much more comprehensive than Medicare. Medicare vs. Medicaid Copyright © eNestEgg Press, LLC.

19. Choosing a Health Plan There's no such thing as standard coverage. Details vary enormously from one plan to another. The best value is not necessarily the plan with the cheapest premium or the one with the most benefits. It's the plan that covers the health services you want and need for the lowest out-of-pocket expense. How to chose a plan Finding good heath insurance How the major plans compare Copyright © eNestEgg Press, LLC.

20. Affordable Health Care Act- Changes Legislation passed in 2010 (often called Obamacare) will greatly change the way insurance impacts your personal financial planning. How Obamacare works How Obamacare Will Impact Your Taxes Copyright © eNestEgg Press, LLC.

21. Keeping your health costs down Live a healthy life: Smoking, drinking, and drug use can all have a serious impact on your health, and your medical costs. Smokers can pay as much as 15% higher for their premiums. Impact of smoking Stay in shape. Being overweight or obese causes higher rates of heart disease, cancer, diabetes, and many other health problems. Financial costs of being overweight Copyright © eNestEgg Press, LLC.

22. Keeping your health costs down Do your homework. Review and research procedures before they're done. If you have an acquaintance who's a medical professional, use that resource. Make sure your not wasting your money Pay attention to your prescription drug costs. It is the fastest growing expense in American medicine. Many common prescriptions have a generic version, which can add up to big savings. Ways to Save on Prescription Drugs Ways To Save On Medical Bills Ways To Cut Health Care Costs Copyright © eNestEgg Press, LLC.

23. Question Cluster 3 Copyright © eNestEgg Press, LLC.