chapter 5 health 101

what is a single payer

who pays for health insurance, covers fee and government pays

universal healthcare

everybody has access, more equal standard oracle, decreases excess spending

trade offs of universal health care

longer wait times, treatment can take longer

public health coverage

state run, cheaper or free, Lower deductible, limitations on who they can see, limited provider choices

private health care

through employer or individually purchased, more expensive, more access to who you can see, not an eligibility, based on who can afford it

the current healthcare system can be traced back to

WWII, as health costs increases, employer coverage became too expensive for small businesses

in 2010

obama was the first president to overhaul the US healthcare system with ACA

bronze insurance metal

little amount of money upfront, if needing care, pay out of pocket

platinum insurance metal

lots of money upfront, but if needing care; insurance pays majority

indemnity plan

premiums (monthly payments) payout all claims

medicare

only for individuals 65+

part A of medicare

hospital stays, nursing homes, long term care facility

part B of medicare

covers doctors visits, ambulance rides, outpatient services, have a monthly payment based on income

part C of medicare

private insurance you can pay for, same benefits, medicare advantage

part D of medicare

pharmaceutical insurance

medicaid

for low income individuals, funded through government but states do a lot of information with medicaid, dictating eligibility criteria

HMO (health maintenance organization)

low cost, in network providers, limited network of hospitals and doctors offices, identify primary care physician, become care coordinator

PPO (preferred provider organization)

have more flexibility on who you can see, higher premiums, preferred network, going out of network will still support you, see specialist without referral

certified application counselor

marketplace navigators, certified to give unbiased information about coverage, assists with electronic and paper applications