Mr. Woodington’s Money Management II

Options for individuals seeking health insurance not covered by their employer

Tips for purchasing individual health insurance plans

Government provided health care programs Medicare Medicaid

The majority of citizens receive health care coverage through employer provided programs

Reasons people do not receive coverage through their employer: Not offered/eligible Self-employed Too expensive for individual to purchase

Individuals who do not receive coverage from an employer or qualify for a government program, will have to purchase an individual health insurance plan

These options mirror those offered by employers, including HMOs and PPOs

Individually purchased, coverage is more difficult/expensive to purchase Policies are individually underwritten Complete medical history is under scrutiny

Be honest! Disclose ALL medical problems you have had,

no matter how insignificant it may seem Insurance companies may write a provision,

called a rider, into your policy which will not pay for any pre-existing conditions

Insurance companies may cancel your policy using a practice called rescission.

This occurs when they have received a claim you have filed and reviewed your application and medical history for undisclosed conditions or inconsistencies

Buy! But only what you need Over 60 percent of bankruptcies in the US are

the result of medical bills Review your risk management strategies

What risks can you afford to take? What risks can you not afford to take? Deductible amount?

Married? Use your spouse’s coverage! The job may not provide much in compensation

beyond the health care coverage, yet this may be the difference when faced with catastrophic illnesses

Federally funded health insurance program

Available to people: Over 65 years of age With certain disabilities Permanent kidney failure Lou Gehrig’s disease

Medicare helps with the cost of health care but does not cover all expenses

Part A – Hospital Insurance Covers the cost of inpatient care Participants may have to pay a single

annual deductible, may receive coverage at no cost

Part B – Medical Insurance Covers a variety of doctor and medical

services not covered, or fully covered, by Part A

Has a deductible and coinsurance provision

Part C – Medicare Advantage Plans Combines Parts A & B Coverage is provided by private insurance

companies approved by Medicare Cost may be lower than original Medicare

plan Extra benefits provided

Part D – Prescription Drugs Voluntary to join Requires a monthly premium Coverage is provided by approved, private

insurance companies

Although Medicare effectively covers many medical costs, there are some expenses it will not cover: Certain types of skilled or long-term nursing care Routine checkups Out-of-hospital prescription drugs Dental care Most screening tests & immunizations

Medicare also limits the amount it will pay for the services it does provide. Any difference between Medicare’s approved amount and the final bill is the patient’s responsibility

Provides health care coverage for: Lower income individuals & families The elderly & people with disabilities

Financed through a combination of state and federal funds

Administered by individual states Eligibility is determined by a number of

factors. Check with individual states for specific qualifications

Although specific coverage varies from state to state, Medicaid is typically comprehensive enough so people do not need supplemental insurance.

Typical Medicaid benefits include Physicians’ services Hospital inpatient and outpatient services Lab services Skilled nursing & home health services Prescription drugs Eyeglasses Preventive care for people under 21

Individuals who do not receive health insurance coverage through their employer have options!

Purchasing individual health insurance policies can be more difficult. It is important to be honest and consider other options.

The government provides health care coverage through Medicare and Medicaid. Each has specific criteria for eligibility and provides varying coverage options.