Health Insurance Literacy Understanding Basic Health Insurance - - PowerPoint PPT Presentation

Health Insurance Literacy

Understanding Basic Health Insurance Terms

Presented by: Debi Lang Debbie Raymond

Massachusetts Health Care Training Forum April 2015

After this presentation you will be able to:

• Define health insurance literacy
• Discuss the importance of health insurance

literacy

• Explain the meaning of some basic health

insurance terms to your clients

• Recognize appropriate resources and tools to

assist with health literacy challenges

Objectives:

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What is Health Insurance Literacy?

“The Health Insurance Literacy Expert Roundtable defines health insurance literacy as the “degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their own (or their family’s) financial and health circumstances, and use the plan once enrolled.”

“Health Insurance Literacy”, CMS National Training Program,

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Why is Health Insurance Literacy Important?

Individuals that understand health insurance terms:

• Are able to compare and choose an insurance

plan that fits their healthcare needs

• Are able to compare and choose insurance

plans that better fit their budget and avoid unnecessary high‐cost medical bills

• Use their benefits wisely resulting in improved

health and disease prevention

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How Do I Decide?

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http://healthpopuli.com/2010/09/27/blondie-and-dagwood-on-the- health-economy/

Knowing how to explain basic health insurance terms to your clients is important! Shopping for health insurance can be:

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Premium: The cost to purchase a health insurance plan.

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Network:

Doctors, Nurses, Specialists, Physical and Occupational Therapists, Mental Health providers Hospitals, Nursing Homes Labs Pharmacies

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In Network:

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Out of Network:

Deductible:

The amount you must pay for most covered services before the plan begins to pay.

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Jane’s health insurance coverage just

• began. She has not met her annual

$1500 deductible yet. She visits her doctor for a sick visit (e.g. sore throat and cough). The cost of the covered service is $125.

Jane pays = $125 Her plan pays = $0

Certain in-network expenses may not be subject to the deductible, which means your insurance may cover all or part of the cost. Prescription medication, immunizations, screenings, office visits…..always check with your plan if you are not sure.

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$1500 $1500 $1500 $500 = Family Deductible $5000 A family may meet their annual “family” deductible without each person having to meet their “individual” deductible.

Out-of-Pocket Limit

The most you pay during a 12‐month policy period. This limit doesn’t include the premium, or payments for services your plan doesn’t cover.

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Summary of Benefits

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CMS: Summary of Benefits & Coverage & Uniform Glossary

Using Benefits

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Covered Service:

“A healthcare provider’s service or medical supplies covered by your health plan. Benefits will be given for these services based on your plan.” (Medical Mutual 2014)

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Co-Pay:

The fixed amount your plan requires you to pay when you receive a covered service (a co-pay is usually paid at the time you receive the service).

YOUR CO-PAYMENT

Is due at the time

• f your visit.

Thank You

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Co-insurance:

The amount you pay for your share of a covered service, calculated as a percent. Co‐ insurance starts once you’ve met your deductible. You also may have a co‐pay.

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Summary of Benefits

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CMS: Summary of Benefits & Coverage & Uniform Glossary

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CMS: Summary of Benefits & Coverage & Uniform Glossary

The Insurance Card:

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Center for Health Guidance ACA-Consumer-Guide-2014

The Insurance Card:

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Center for Health Guidance ACA-Consumer-Guide-2014

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Suppose that under your health insurance policy, hospital expenses are subject to a $1,000 deductible and $250 per day

• copay. You get sick and are hospitalized for 4 days, and the bill

(after insurance discounts are applied) comes to $6,000. How much of that hospital bill will you have to pay yourself?  $0  $1,000  $2,000  $4,000  Don’t know

From: The Henry J. Kaiser Family Foundation

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True or false: If you receive inpatient care at a hospital that participates in your health plan’s provider network, all the doctors who care for you while you’re in the hospital will also be in network?  True  False  Don’t know

From: The Henry J. Kaiser Family Foundation

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Suppose your health plan covers lab tests in full if you go to an in-network lab, but only pays 60% of allowed charges if you go

• ut of network. You forget to check and go get your blood test at

a lab that turns out to be out of network. The lab bills you $100 for the blood test. Your health insurance allows only a $20 charge for that test. How much would you have to pay out of pocket for that lab test?  $0  $40  $80  $88  Don’t know

From: The Henry J. Kaiser Family Foundation

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• The Health Connector, based on feedback from this

year’s Open Enrollment events, is working on a Health Plan Shopping Guide for consumers and a Health Plan Shopping Training for assisters

• The assister training is focused on shopping for an

unsubsidized QHP on the Health Connector website

• Training will be held at the end of May and an invite for

the training will go out through the MTF listserv

• The Health Plan Shopping Guide for consumers will

be available for download from MAhealthconnector.org

Stay Tuned!

Resources for Assisters

• Massachusetts Health Care Training Forum (MTF)

www.masshealthmtf.org

• MassHealth

http://www.mass.gov/eohhs/consumer/insurance/masshealth‐member‐info/

• Massachusetts Health Connector

https://www.mahealthconnector.org

• US Department of Health and Human Services

www.Healthfinder.gov

• Center for Medicare and Medicaid Services (CMS)

http://marketplace.cms.gov

• Glossary of Health Coverage and Medical Terms

http://marketplace.cms.gov/help‐us/2partner‐with‐us.html

• From Coverage to Care

http://marketplace.cms.gov/help‐us/c2c.html

• Institute of Medicine Roundtable on Health Literacy
• http://iom.edu/Global/Perspectives/2013/LetsAsk4.aspx

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