-Health insurance covers the cost of health care

expenses for the insured.

What is health insurance?

Terms

Provider: place or someone to receive care from

ex: Clinic, Hospital, Doctor, Lab, Pharmacy

Insured: person who is covered by health

insurance

Subsidize: insurance pays part of the cost to

reduce prices for the insured

Health Insurance in the U.S.

Unlike other countries (e.g. Australia), insurance

in the U.S. is not a given 'right'.

It is often bought out-of-pocket or given

through a second party, like an employer

Insurance plans covers you in different areas, such as vision, dental, prescriptions, etc.

Types of Insurance

Public Insurance is a public option created and

given by the government in the United States.

Private Insurance is given by organizations or

employers.

Public Insurance

Two most common public health insurance

in the U.S. is Medicare and Medicaid.

Children's Health Insurance Program and

Special Programs are also public insurance.

Medicare

Medicare is given to adults who

-is age 65+

-certain disabilities for younger people

-End-Stage Kidney Disease (Renal)

The Four Parts to Medicare

Medicare comes in four different parts:

Part A, Part B, Part C, and Part D. Each area of

Medicare covers specific services.

Medicare Part A

Is also called Hospital Insurance. This covers

inpatient (hospital stays) and outpatient care

that includes skilled nursing facilities, hospice

care and other health care, such as home care.

Medicare Part B

It is also called Medical Insurance. This covers

-doctors' visits

-preventative care/ services

Medicare Part C

Is also called Medicare Advantage Plans. This

plan is given by private insurance that works

with public insurance. These plans provide the

benefits from Part A and B, but may also save

you more money than the Original Medicare

(Part A and Part B).

Some Medicare Advantage Plans

Health Maintenance Organizations (HMO):

group of providers that agreed to lower cost

for people who have these plans.

Preferred Provider Organization (PPO):

more flexible than HMOs, which allows you to

choose your preferred provider and still be

covered.

Medicare Part D

Is also called Prescription Drug Coverage. This

part adds to Original Medicare (Part A and Part

B) and some medicare cost plans. These are

offered by insurance companies and some

medicare approved private companies.

Medicaid

Medicaid is another public insurance that is

given depending on each state. Each state has

guidelines to determine who qualifies or

who is eligible.