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HEALTH INSURANCE
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A way to help pay for health care when it is necessary
What is it? A way to help pay for health care when it is necessary
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Private Insurance Plans
Blue Cross/Blue Shield United Health Care Kaiser Permanente Travelers Joe Smith Insurance
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AMOUNT OF MONEY YOU PAY EVERY MONTH TO KEEP THE INSURANCE ACTIVE
Premium AMOUNT OF MONEY YOU PAY EVERY MONTH TO KEEP THE INSURANCE ACTIVE
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DEDUCTIBLE If you receive any kind of service, it is the amount of money you have to pay BEFORE the insurance company will pay Any money to the provider
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CO- INSURANCE The percentage of the bill that you have to pay, and the percentage of the bill that your insurance company has to pay. Usually given as a fraction as 80/20, 90/10, 70/30
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Co-payment The amount of money you have to pay at the time you receive care. Usually will be on your card.
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Government Health Insurance
Medicare Medicaid Peachcare Tricare
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MEDICARE Insurance for persons 65 years old and older
Persons who are disabled and have been on Social Security for 2 years Blind Individuals
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MEDICAID Insurance for persons who have low or no income
Persons receiving Kidney Dialysis
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PEACHCARE Provides Insurance for children of families who have income, but not enough to purchase insurance. Does not cover the parents
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TRICARE Insurance for Active Military Personnel and their families
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Special Considerations
HMO Health Maintenance Organizations Advantages Focus on wellness Pay for physicals Usually no deductibles Disadvantages Only can use their doctors & hospitals
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PPO Preferred Provider Organization
Insurance that gives you a list of doctors & hospitals that they will pay for They will cover other doctors, but not as well
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Worker’s Compensation
Insurance that will pay for any injuries that you get while on the job The employer pays the premiums
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MANAGED CARE Program that began in the 90’s. Says :
ALL HEALTH CARE MUST HAVE A PURPOSE or else insurance will not pay Advantage Keep cost of Health care down Disadvantage Often needs a second opinion Might not get what you believe you need
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How do you calculate how much you have to pay???
Start with how much you owe Subtract deductible Calculate co-insurance Add deductible back into your share Lets figure it out !!!
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HOW DO YOU CALCULATE YOUR MEDICAL EXPENCES?
Subtract deductible Figure out co-insurance amounts Complete final calculations LETS DO SOME MATH !!!
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