CH 9 1 Health care costs for individuals and families a 1 trillion a year is spent on health care b on an individual basis this represents over 15 of personal income largest share goes for hospital care 42 i ii physicians services 22 iii prescription drugs 10 iv dental services 5 v nursing home care 9 c average families midrange incomes of 30 40k a year spend an average of 1 500 or about 4 5 percent of their earnings d most Americans have employer based private group health insurance e Three main types are private group insurance individual health insurance and government programs 2 Rising costs five main reasons a Advances in medical technology and care prolong life and many new technologies are expensive and are used for longer periods of time b Decline in lengthy hospital stays outpatient services people are able to recover at their homes instead of at the hospital c Demographics people are living longer d Increases in third party payments payments usually go through insurance companies or the government e Rising costs in labor prescriptions supplies and administration 3 Overview of health care coverage a Besides the large percentage 61 of americans with employer based health insurance 25 rely on Medicare and Medicaid and 14 15 have no insurance 4 Children health plans and insurance a Federal government is exploring different ways to ensure better health care coverage for these children b Complicated because about 3 million uninsured children are eligible for Medicaid but their parents have not signed them up c Some don t know they qualified and others are deterred from the complicated rules 5 Health Care plans or insurance marriage and divorce a c If married they have insurance plans and should make appropriate decisions on the proper plan for the both of them b Emplyer based plans offered by companies have various rules about who is covered and under what conditions If a couple divorces medial coverage under a formal spouse s medical plan can be continued for 36 months if former spouse works for a company with 20 or more employees 6 Financial pains of childbirth a Most insurers pay obstetricians a single global fee for prenatal care delivery postpartum checkup etc b Others have patients pay the 6000 bill for a routine pregnancy in monthly installments at the start of the first visit c A doctor who participates in a managed health plan has to accept the insurer s fee schedule 7 Providers three main choices a Managed care i Managed care refers to plans that combine the financing of health related services and the delivery of health care ii A list of health care providers are identified by the plan iii Don t pay a fee for service but your health cre is covered by a pre paid plan iv Health Maintenance Organizations HMOs alternative to health insurance that has gained prominence in the past 20 years 1 Don t provide health insurance they provide health care 2 Pay a fixed premium in advance in return for a wider range of health care services 3 Must go to an HMO doctor and facility 4 All covered in one monthly fee 5 Oldest 1933 and largest HMO is Kaiser Permanente which covers California and 15 other states 6 Ways to select HMO a Visit them and compare them as you would shop for products b Ask about services including copayments and reduced cost precriptions i Copayment pay a portion of bill such as 5 to 10 each visit when it is 50 500 a year c Ask friends coworkers neighbors v Preferred Provider Organizations PPOs group of physicians or hospitals provide services to employees through their employers who get a group discount price 1 Offered by Blue Cross and Blue shield hospital chains and insurance companies 2 Looser form of managed care than HMOSs vi Point of service organizations or Products POS combines traditional insurance coverage and HMO coverage 1 Most rare choice because it has the highest deductible 2 You have two policies an HMO and traditional coverage and two carriers an HMO and insurance company although you have only one premium to pay b Individual health coverage i Blue cross and Blue shield and insurance companies offer insurance to individuals as well as to companies ii Tends to be very costly iii People can reduce costs by shopping around for best price for coverage needed and watching for group insurance which is usually less expensive c Government Programs and Medicaid i Two largest government sponsored programs are Medicare ii Medicare federal health insurance program for people 65 or older people of any age with permanent kidney failure and certain disabled people 1 Sponsored b Health Care Financing Administration 2 Has both hospital part A and medical part B insurance limited assets iii Medicaid health care program for people with low income and 1 Covers long term care hospital and medical expenses iv 25 have medicare Medicaid v 13 15 DO NOT have health insurance d Choosing a plan i What are my health care needs and those of my family ii Do I regularily use preventive care Will someone need annual checkups mammograms immunizations Is the policy renewable iii Do I need specialists iv v Do I mind filling out paperwork vi Does the company have a good reputation vii Have I read the policy e How to save money on health insurance i Comparision shopping go online to compare premiums deductibles copayments Don t buy more than you need ii Preexisting condition exclusions preexisting conditions are usually health problems you went to see a physician about within the six months before the policy went into effect iii Reviewing coverage needs don t pay for coverage you don t need iv Evaluating the plan policy after purchase is the billing process handled efficiently f Choices in private health insurance i Basic Medical expense insurance covers hospitalization and most outpatient treatment ii Major medical insurance covers large medical insurance 1 Useful in event of catastrophic illnesses or injuries 2 Includes a High deductible participation provision and high limit of liability iii Disability income insurance pays benefits to policy holders when they become incapable of working 1 Policies typically pay 60 to 80 of one s paycheck 2 Coverage can be short term or long term 3 Elimination periods period of time that must elapse before insurance payments begin 4 Workers compensation money paid if a disability is due to illness or injury from a job a Usually pay two thirds of workers lost wages up to a maximum amount iv Medicare supplement insurance medigap insurance 1
View Full Document
Unlocking...