Affordable Care Act

Federal Act that made healthcare more affordable

Provided more healthcare to those with well below the poverty level

Mandated that all individuals needed insurance

Types of Private Insurance

Insurance an individual can sign up for and pay for on their own or as a benefit of employment.

Blue Cross

Harvard Pilgrim

Fallon Health

Public Health Insurance

Insurance that is paid for or subsidized by Federal and/or State governments.

Ex. medicare and medicaidPoint of Service

Premium

the monthly fee for your health insurance

Fees vary for individual, family or couple plans

3 Factors that Insurance premiums are based off of

age

location

smoking habits

deductible

the amount the insured must pay before insurance kicks in to cover costs

Co-inurance

the percentage of cost that the insured must pay for services

Out of Pocket Maximum

The total amount insured would have to pay in a year before the insurance will pay for everything else.

Actuarial Value

The percentage of costs that the insurance plan pay for for medical expences

Metals

the varying types of levels within an insurance company

Fees for premium and co-insurance vary

Platinum is most expensive premium with lowest co-insurance

Bronze has cheapest premium but higher co-insurance and deductibles

Catastrophic Plan

insurance plan for individuals that are under 30

Very low premium, high deductible

For mostly emergencies, some cover preventative care

HMO

Health Maintenance Organization'

Must have Primary Care Physician

Must see in-network doctors

Need referrals for specialists

EPO

Exclusive Provider Organization

Hybrid between HMO and PPO

Can see out of network doctors without referral but will have to pay own expenses

PPO

Preferred Provider Network

Do not need primary care or referrals to see specialist

Can see out of network doctors and only have to pay a portion of the expense

POS

Point of Service

Need a Primary Care

Need referral but can see doctors outside of network and insurance will pay some of the fees

Medicare

Public Insurance paid for by Federal Government

For individuals 65 and over, or who have a disability or kidney failure

Different types plans A, B, etc cover different expenses

Medicaid

insurance that is funded by Federal and state funds

State has say on coverage

Covers low income, children, disabled and blind

CHIP

Children's Health Insurance Program

Covers children whose parents do not make enough to afford private insurance but are not eligible for medicaid.

Veteran's Health Benefits

For veteran's that have medical conditions related to their time of service

Tricare

Federal insurance for all active and retired military and their families

Worker's Compensation

Insurance for those who are injured on the job

Covered by state and employer

Pays for lost wages and medical expenses due to injury on the job