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Insurance, the Healthcare Crisis, and the ACA

Insurance, the Healthcare Crisis, and the ACA. Question 1 - 10. What kind of insurance did Ms. Mueller have?. Answer 1 – 10. Cigna PPO. Question 1 - 20. What is the difference between a copay and coinsurance?. Answer 1 – 20. Copay = fee that is paid at the time of service

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Insurance, the Healthcare Crisis, and the ACA

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  1. Insurance, the Healthcare Crisis, and the ACA

  2. Question 1 - 10 • What kind of insurance did Ms. Mueller have?

  3. Answer 1 – 10 • Cigna PPO

  4. Question 1 - 20 • What is the difference between a copay and coinsurance?

  5. Answer 1 – 20 • Copay = fee that is paid at the time of service • Must be paid no matter where you are in the deductible • Coinsurance = where the expenses are split between the patient and the insurance company after the deductible has been reacher

  6. Question 1 - 30 • What is the difference between an HMO and a PPO?

  7. Answer 1 – 30 • HMO: an insurance plan where you are restricted to a set of doctors • You must have a referral to see a specialist • Important for doctors to be “in-network” • PPO: an insurance plan where you do not need a referral to see a specialist • Insurance pays SOME for “out of network” visits

  8. Question 1 - 40 • Where are 3 places where you can receive health insurance?

  9. Answer 1 – 40 • Employer, private, government

  10. Question 1 - 50 • Compare and contrast Medicare and Medicaid

  11. Answer 1 – 50 • Medicare and Medicaid are both government insurance plans. • Medicare = elderly (age 65 and up) • Medicaid = low-income

  12. Question 2 - 10 • What is 20% of $650?

  13. Answer 2 – 10 • $130

  14. Question 2 - 20 • For this medical insurance, there are no copays or deductibles. There is an 80/20 coinsurance. • Drs office visit: $130 • Prescription: $70 • X-ray: $1300 • How much would the patient pay?

  15. Answer 2 – 20 • $300

  16. Question 2 - 30 • A health plan excludes vision and dental. There is a $750 deductible and a 70/30 coinsurance. • Eye exam: $75 • Knee Surgery: $5000 • Drs. Visit: $130 • How much would the patient pay?

  17. Answer 2 – 30 • 75 + 750 + 1314 = 2139

  18. Question 2 - 40 • A vision plan includes an eye exam and a $15 copay for glasses. The health plan has a $500 deductible and 80/20 coinsurance • Eye appointment: $100 • Glasses: $150 • Physical: $50 • Prescription: $35 • How much will the patient pay?

  19. Answer 2 – 40 • $15 copay for glasses • $0 for eye appointment • $85 for medical bills • Total: $100 (did not meet deductible)

  20. Question 2 - 50 • A health plan includes dental (2 cleanings/year) and general health, but not vision. There is a $1000 deductible and 80/20 coinsurance. • 2 teeth cleanings: $130 each • Chiropractor visits: $500 • Prescription: $130 • Drs office visits: $200 • What will the patient pay?

  21. Answer 2 – 50 • $0 for dental visits • $830 (did not meet deductible)

  22. Question 3 - 10 • What percentage of Americans are currently uninsured?

  23. Answer 3 – 10 • ~16-18%

  24. Question 3 - 20 • What are the two reasons a person may be uninsured?

  25. Answer 3 – 20 • Possible answers: Cannot afford insurance, employer insurance not offered, denial for pre-existing conditions

  26. Question 3 - 30 • What is COBRA?

  27. Answer 3 – 30 • States that a person laid off from their job can still use their health plan for 18 months after becoming unemployed, but must pay the entire premium.

  28. Question 3 - 40 • Why might a disabled person not have insurance?

  29. Answer 3 – 40 • Denial b/c of preexisting condition • Cost • Premiums inflated because of health status • Cannot work so cannot afford cost

  30. Question 3 - 50 • Why might a person who is HIV+ not have insurance?

  31. Answer 3 – 50 • 1) cost • 2) pre-existing condition • 3) gov’t benefits don’t kick in until they are very sick

  32. Question 4 - 10 • True or false: Small businesses are fined if they do not offer their employees insurance.

  33. Answer 4 – 10 • False: large employers are fined

  34. Question 4 - 20 • What is the Individual Mandate?

  35. Answer 4 – 20 • Provision that states that all people must have health insurance or else pay a fine

  36. Question 4 - 30 • How old can a young person stay under his/her parents’ health plans?

  37. Answer 4 – 30 • 26

  38. Question 4 - 40 • Give me 2 provisions that the insurance companies would dislike.

  39. Answer 4 – 40 • Possible answers: • Guaranteed coverage • Cannot base premiums off of health status • Cannot drop coverage because you are sick • No lifetime limits

  40. Question 4 - 50 • What are your options if you make too much for Medicaid, but too little to afford private insurance under the ACA?

  41. Answer 4 – 50 • Government subsidies

  42. Question 5 - 10 • What is Ms. Mueller’s favorite color?

  43. Answer 5 – 10 • Purple

  44. Question 5 - 20 • True or false: Ms. Mueller has held a snake before.

  45. Answer 5 – 20 • True!

  46. Question 5 - 30 • What is Ms. Mueller’s alarm set for in the mornings? • A: 6:30 • B: 3:00 • C: 4:30 • D: Ms. Mueller never sleeps

  47. Answer 5 – 30 • 4:30 (although I press the snooze a few times before getting up)

  48. Question 5 - 40 • How much was taken out of Ms. Mueller’s paycheck for her health insurance?

  49. Answer 5 – 40 • Around $20

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