Types of Health Insurance


Traditional health Insurance:

  • Tend to be the most expensive
  • Most flexibility for choosing providers



Health Maintenance Organizations (HMOs):

  • Lower co-payments
  • Covers cost of preventive care
  • Limited choice in providers      



Preferred Provider Organizations (PPOs):

  • Lower co-payments
  • More flexibility for choosing
    providers [than HMOs]



Point of Service Plans
(POS Plans):

  • Combines Traditional + HMOs
    to allow choice of provider in or
  • In-network provider: coverage under HMO guidelines
  • Out-of-network provider: use deductible (like traditional)
    until amount reached and insurance pays for portion of expenses

Types of Payments

  • Co-payments: Amount of money you pay for medical services or prescription.

  • Coinsurance: You and insurance split cost after deductible reached.

  • Deductible: Amount you pay before insurance will pay claims (one-year period).

  • Network providers: Providers in agreement with insurance company to provide services at specific rates (often discounted).

  • Non-network providers: Providers not in agreement with insurance company; higher cost than network providers.

  • Out-of-pocket annual maximum: Maximum amount you would have to pay in one year for covered services per terms of the insurance plan.


Coverage For People With Disabilities

  • Free (or inexpensive medical benefits)
  • For those with disabilities
  • Medical health Insurance (Under 65)
  • For those with certain disabilities or any age with end-stage renal disease
  • If those with disabilities don't qualify for disability benefits
  • Affordable coverage

What is Consolidated Omnibus Budget Reconciliation Act (COBRA)?

· Gives workers right to choose to continue group health coverage through group health plan for specific period of time
· Requirements for eligibility:

o Group health plan covered by COBRA
o Qualifying event must occur (job loss, reduced hours, transition between jobs, death, divorce)
o Individual must be qualified beneficiary for the event

· You are given at least 60 days to decide if you would like to continue coverage

What is The Affordable Care Act (ACA)?

· Access to affordable health insurance (medical, dental, vision, etc.). Citizens can secure health insurance through the state and federal governments. Children can stay on family’s plan until age 26.
· Next open enrollment period: November 1, 2017-January 31, 2018
Re-enroll in current plan
Choose a plan for the first time
Choose a new plan to replace the current one
Make any changes to existing plan
· Life changes that allow enrollment or changes in plan year-round
Marriage or divorce
Giving birth or adding a dependent to the family
Loss of other coverage
Move to a new state
If you qualify for Medicaid or CHIP
· Apply through ACA Marketplace
Online: healthcare.gov
Phone: 1-800-318-2593 or TTY 1-855-889-4325
In person: Find a center near you at Healthcare.gov

Mail: download application via the website above

What is Long-Term Care (LTC)?

· Not included or extremely limited in most health insurance plans
· Do you qualify? Most require you to be unable to perform a certain amount of daily living activities (i.e. eating, dressing, walking, moving from bed, using the bathroom, bathing)
· What type of care will be covered? (Nursing home, home care, skilled services, housekeeping)
· Amount in benefits? Most have a dollar/day benefit
· Benefits period: Average is 1-6 years
· Benefit adjusted for inflation?
· Is there a waiting period before benefits begin?
· More information read Guide to Long-Term Care Insurance at Publications.USA.gov