Health Insurance - Part 3 (ACA & Pennie)

Health Insurance Part 3
Consumer Health Unit

What are our intentions today?

-Differentiate between types of insurance programs and terms by actively participating with the slides.

-Understand the different types of insurance  by analyzing which health insurance plan available would best fit the students’ needs.

During the 'terms 1' lesson we reviewed cost terms, networks, and policy styles.

Let's see what you remember!

​

Review Terms Day 1:

Multiple Choice

What is 'Group Insurance' in the USA?

• Insurance coverage offered to employees by the employer
• Insurance policy an individual must purchase on their own
• Insurance offered by the government
• Insurance offered to a special group of people

Multiple Choice

Premiums are:

• Percentage of the allowed amount that is the patients responsibility.
• Fee paid for the health insurance coverage
• Purchased by an organization for the benefit of members
• Portion of the cost of service to be paid by the insured

Multiple Choice

Deductibles are:

• The amount of money you must pay each year before the insurance company pays anything
• A type of medical savings account
• A type of policy in which you save for emergencies
• A shared expense between the insured and the employer

Multiple Choice

Co-payments are:

• Coordination of benefits

• Portion of the cost of service to be paid by the insured (a set dollar amount to be paid each time you see the doctor)

• Term of conditions not covered by the insurance company

• Provider bill for service

During the 'terms 2' lesson we reviewed HMO vs. PPO, networks, and government policies.

Let's see what you remember!

​

Review Terms Day 2:

Multiple Choice

PRICE: Which is one has the more expensive premiums?

• HMO
• PPO
• BOTH
• NONE

Multiple Choice

Which is NOT true of HMOs?

• HMOs offer the cheapest health insurance option

• HMOs are the most restrictive. You can only choose in-network providers.

• HMO's require a referral from your Primary Care Physician.

• HMO's allow you to choose providers out-of-network

Multiple Choice

Which plan requires patients to get REFERRALS to see specialists?

• HMO
• PPO
• BOTH
• NONE

Multiple Choice

What is the main goal of the US Government's Medicare and Medicaid programs?

• To fund medical research and development

• To cover healthcare costs for veterans and their families

• To provide free healthcare to all citizens

• To provide insurance for low-income households and care for seniors

Multiple Choice

At what age is a customer can qualify for MEDICARE?

• 58

• 60

• 63

• 65

Poll

Are we ready to look at some REAL health insurance policies?

• Yes - let's go!

• OK!

• I am still confused about health insurance...

• NO!

Pennsylvania Health Care / ACA

Starting 10/3/13, the Health Insurance Marketplace (now know as PENNIE) made it easier for Pennsylvanians to:

• compare qualified health plans

• get answers to questions

• find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.

Uninsured Pennsylvanians who are eligible for coverage through the Marketplace. Before the ACA started in 2013:

1,242,350 (12%) are uninsured and eligible

928,243 (75%) have a full-time worker in the family

491,258 (40%) are 19-34 years old

864,180 (70%) are White

201,028 (16%) are African American

114,374 (9%) are Latino/Hispanic

33,494 (3%) are Asian American or Pacific Islander

707,872 (57%) are male

1,141,720 (92%) of PA uninsured and eligible population may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Pennsylvania takes advantage of the new opportunity to expand Medicaid coverage under the Affordable Care Act.

Healthcare Marketplace:

Let’s see some plans available:

• Click on this link: WWW.PENNIE.COM

• On the ‘Pennie’ site, click ‘get covered’ at the top right.

• Next - click ‘browse for health & dental plans.’

• Once you are on this link, please follow the prompts. 

  • You can make up any profile would like or model your own family.

  • Do not give the site your personal information (phone number, email, etc.) other than zip code.

  • Birth dates are needed to see the age of every individual that needs coverage.

• Goal - to see names of insurance companies and premium prices for the profile you submitted. 

• There will be follow up questions to show your evidence you did this activity. DO NOT CLOSE THE PENNIE WEBSITE/TAB UNTIL WE COMPLETE THIS ACTIVITY.

Open Ended

List the name of the ONE health insurance company and cost per month (premium) for one plan you saw on this website.  You need both to earn full credit

Open Ended

Tell me something you learned from this activity:

Is insurance expensive or is it cheap? Is insurance complicated to shop for? What is something new you learned from shopping?

What else is out there?
What do other developed countries do?

It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes. Universal healthcare is not a one-size-fits-all concept

​ Universal Healthcare:

Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs

​ Single Payer:

• These two plans are centrally controlled healthcare system (government) = pay higher taxes

• Sometimes requires supplemental health insurance (to strengthen the plan)

Single Payer / Universal:

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1. ​You can stay on your parent/guardian insurance until the day you turn 26 (as long as they pay your premiums).

2. Joining the military? You will join their insurance.

3. Getting a job that has insurance? You can join your employer's plan.

4. You can buy your own insurance (we did this earlier!).

   You are not required to have health insurance in the USA...

What happens to my insurance when I am done high school?

Open Ended

Select one of the following to respond to as your exit ticket:

1. A question you have about these notes you want the teacher to explain again

2. A reaction about health insurance in the USA or to your health insurance policy

3. Something you learned that was new regarding health insurance