Chapter 11

Roughly about 10% of all dollars are spent on

health care

factors that have led to increasing health care costs":

• The use of expensive technologies

• An increased number of crimes and accidents

In order to contain health care costs, physicians are encouraging consumers to pay with ? for routine medical care and lab services.

Cash or debit

A good health insurance provides:

• at least $1 million lifetime maximum for each family member

• a provision so the policyholder will pay no more than $6,000 out of pocket a year

Health insurance is one way people protect themselves against economic losses due to

• disability

• illness

• accident

the following activities have been undertaken by health care professionals and consumers to keep the overall cost of health care down

• initiating community health education programs

• getting involved in community health planning

• offering incentives to encourage preventive care

A "good" health insurance plan pays at least __% percent of out-of-hospital expenses once a yearly deductible for the individual and family have been met.

80

Which insurance supplements Medicare by filling the difference between Medicare payments and medical costs not covered by Medicare?

medigap insurance

What program was designed to provide medical assistance to low-income individuals and families?

Medicaid

? insurance makes up the difference between Medicare payments and medical costs not covered by providing supplemental insurance that can be purchased.

Medigap or medsup

what factors has not been attributed to increasing health care costs?

a focus on healthy living options

coordination of benefits (COB)

A method of integrating the benefits payable under more than one health insurance plan.

hospital expense insurance

Pays part or all of hospital bills for room, board, and other charges.

surgical expense insurance

Pays part or all of the surgeon’s fees for an operation.

Good health insurance should:

• Offer basic coverage for hospital and doctor bills

• Provide at least 120 days hospital room and board in full

• Provide at least $1M lifetime maximum for each family member

• Pays at least 80% of hospital expenses

• Impose no unreasonable exclusions

• Limit out-of-pocket expenses to no more than $4,000 - 6,000 a year excluding dental, optical and prescription costs.

Blue Cross

An independent membership corporation that provides protection against the cost of hospital care.

Blue Shield

An independent membership corporation that provides protection against the cost of surgical and medical care.

managed care

Prepaid health plans that provide comprehensive health care to members.

health maintenance organization (HMO)

A health insurance plan that provides a wide range of health care services for a fixed, prepaid monthly premium.

preferred provider organization (PPO)

A group of doctors and hospitals that agree to provide health care at rates approved by the insurer.

exclusive provider organization (EPO)

A network that renders medical care from affiliated health care providers.

Medicare

A federal health insurance program for people 65 or older, people of any age with permanent kidney failure, and people with certain disabilities. The program is administered by the Centers for Medicare and Medicaid Services.

Medicaid

A program of medical assistance to low-income individuals and families.

disability income insurance

Provides payments to replace income when an insured person is unable to work.