BMAN 341 - Ch 11 Planning for Health Care Expenses

Direct Medical Care Costs

Long-term rehabilitative Costs

Custodial Care Costs

Lost Income

Due to not being able to work from illness or injury

COBRA Law

Affordable Care Act

Designed to address health care issues in the USA by requiring that all persons have a health care plan

Qualified Health Care Plan

All health care plans must have this requirement, must provide 10 essential benefits of adequate coverage

Individual Mandate

Requiring people to buy a health insurance plan (no longer required)

Individual Shared Responsibility Fee

the tax penalty for not carrying health insurance

Affordable Care Act provisions

• Cannot be denied coverage for preexisting conditions

• men and woman charged same rates

• Free preventative care and annual checkups

• no limits on payouts

• children can stay on until 26

• No need for referral for provider within network or outside for emergency care

ACA’s first Five essential services

• Ambulatory services like doctors and outpatient services

• emergency visits

• Hospitalizations

• Maternity and newborn care

• Lab services

ACA’s last Five Essential Benefits

• Behavioral health treatment

• Prescription drugs

• Rehabilitative services/ devices

• Preventive/ wellness services

• Pediatric services

Health Insurance Exchanges

Online marketplaces where one may shop for, compare, and purchase a Private health care plan (marketplace.gov)

What does the ACA do for people needing insurance?

No longer mandates, but provides subsidization for health care plans and sets minimum limits to ensure high quality, and sets up marketplace for insurers

Who does the ACA impact?

Those that do not have health insurance by other means, like 15-20% noninsured

Why does the US have the most expensive health care system?

How much is individual shared responsibility fee if you do not purchase health insurance and your income is $40,000?

How do subsidies reduce the price of insurance premiums under the ACA?

If you choose a silver health insurance plan, how much of your out-of-pocket medical costs be paid by the plan?

Bronze Health insurance plan

40%

Silver Health insurance plan

30%

Gold health insurance plan

20%

Platinum health insurance plan

10%

Health Care Plan

Generic name for any program that pays for or provides reimbursement for health care expenses

Group Health Care Plan

Traditional Health Insurance

High Deductible Plans

Health Maintenance Organizations (HMOs)

Preferred Provider Organization (PPO)

Provider-Sponsored Network (PSN)

Worker Compensation

Medicare Parts A, B, and D

Medicare Advantage Plans

Medicaid and Expanded Medicaid

COBRA Rights

May allow continuation of a previous employer-based plan between jobs

Premium Conversion

Flexible Spending Arrangement (FSA)

Medical Letter of Necessity

Health Savings Account (HSA)

Allows tax-sheltered savings when using a high-deductible health plan, health expenditures can be used a itemized deductions, used to incentivize saving for own healthcare expenses

How or how not has managed care reduced the cost of healthcare in America?

Certificate of Insurance

Document or booklet that outlines group health insurance benefits

Coordination of benefits Clause

All policies have this, prevents collecting more than 100% of health care loss

Out-of-Pocket Maximum

Specifies how much must be spent by the insured party in a given year before the plan will pay 100%

Exclusion

Coinsurance

Copay

Long-term care insurance

Factors to consider when selecting long-term care insurance

Degree of impairment required for benefits to begin and Activities of Daily Living

Activities of Daily Living

Three levels of care in long-term care insurance

What is a benefit period for a long-term care policy?

What is a waiting period for a long-term care policy?

Disability income Insurance

Social Security Disability Insurance

Can provide income when the disability is likely to last for one year

Any-occupation Policy

Will provide benefits if you can no longer work at any job

Own-occupation policy

Will provide benefits if you can no longer perform the occupation you had before becoming disabled

Residual Clause

allows for reduced benefits when partial disability occurs

Cost-of-Living Adjustments

Guaranteed Renewability Clause

Who needs disability insurance?

How does one determine their level of need for disability income insurance?

What is the benefit of preparing advance medical directive document?

Advance Medical Directive

A medical guideline that pertains to treatment preferences and the designation of a surrogate decision maker if you are unable to make your own medical decisions

Living Will

Instructs health care providers of your health care wishes should you become terminally ill with no hope of survival and unable to express your wishes

Health Care Proxy

Legal document in which individuals designate another person to make health care decisions if they are rendered incapable of making his or her own wishes

Durable Power of Attorney

A document in which you appoint someone, called an attorney-in-fact, to handle your legal business matters and sign his or her name to your documents

Why should someone make advance directive documents?

What does a living will accomplish?