1. Health Insurance

2. Supplementary and Transitional Insurance
Health Insurance
Supplementary and Transitional Insurance
The federal Government has established two programs for people who are between jobs, lose a job, lose insurance due to death, or lose insurance because of a divorce
Consolidated Omnibus Budget Reduction Act
(COBRA)
Health Insurance Portability and Accountability Act
(HIPAA)

3. COBRA
Gives employees the right to continue their group coverage at their own expense for months
You can quality if…
If you leave your job or are terminated
If you are divorced from the covered employee
If your work hours are reduced below minimum requirements
If you are eligible for Medicare
If you become disabled
If the covered employee dies

4. COBRA
You must pay your share and the employer’s share of the premiums plus an administrative fee
If your former employee goes out of business your plan can be terminated
COBRA can be very complicated so you have to keep up to date with the rules and regulations

5. HIPAA The “portability” law
Protects health insurance coverage for workers and their families when they change or lose their jobs
Unlike COBRA, you do not take your previous health insurance policy with you
Your eligibility of insurability transfers

6. Government-Provided Health Insurance
A healthy population is a benefit to society
The government provides health insurance for citizens it deems most in need
“Entitlement Programs”
Medicaid
Medicare

7. Medicaid Became law in 1963 under the Social Security Act
Provides medical assistance for eligible individuals and families with low incomes and resources
Varies widely from state to state because each state establishes their own guidelines

8. Medicare The nation’s largest health insurance program
Covers 39 million Americans
The largest group covered by Medicare is people over the age 65
Also provides care for people with disabilities

9. Medicare Two types of Plans Type A:
Covers a percentage of hospital bills
Free to anyone who has worked 10 years in Medicare-covered employment
Type B:
Covers non-hospital expenses
Charges a small monthly premium
You must pay a deductible and a co-payment for each

10. Healthcare Problems in the United States
The United States provides the highest quality health care in the world
Despite breakthroughs in medicine, the healthcare system continues to be a source of great frustration
Rising healthcare costs
Large number of uninsured people
Uneven quality of medical care
Considerable waste and inefficiency

11. Rising Healthcare Costs
Healthcare Problems in the United States
Rising Healthcare Costs
Factors accounting for the increase
Rising hospital costs
Due to expensive technology, high labor costs due to shortage of nurses and consolidation of hospitals
Rising prescription drug costs
New technology
Physician cost trends
Due to increased use of specialists

12. Rising Healthcare Costs
Healthcare Problems in the United States
Rising Healthcare Costs
Factors accounting for the increase (continued)
Cost shifting by Medicare and Medicaid
Private patients have to pay more to cover costs of other patients that these programs do not cover
State mandated benefits
States mandate that insurers must provide certain benefits
Higher administrative costs
Includes customer service, information technology, and medical management costs
Uninsured patients, healthcare fraud and abuse of the system

13. Large Number of Uninsured Persons Uneven Quality of Medical Care
Healthcare Problems in the United States
Large Number of Uninsured Persons
An estimated 15 percent of the population does not have health insurance
Uneven Quality of Medical Care
Medical care varies widely depending on the physician, geographic location, and the type of disease being treated

14. Waste and Inefficiency
Healthcare Problems in the United States
Waste and Inefficiency
The administrative costs of delivering health insurance benefits are excessively high
Large amounts of paperwork
Claims forms are not uniform
Defensive medicine by physicians results in unnecessary tests and procedures