Health Insurance Explained PDF

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Health Insurance Explained

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Affordable care act is Obama care Have to pay premium every month or it will get cancel Insured through Medicaid o do not have to pay premium at all o federal gov. and your state take care of that If you insure through new health care market place depending on your income than you may be eligible for tax credit that may pay the portion of you premium Copay—pay something when you visit the doctor Coinsurance --- % of the bill Deductible--- comes out of your own pocket before insurance starts to pay Depend on your insurance o have to pay deductible for all of your care or it apply some of the care like hospital stay--- so read the plan Out of pocket maximum --- your insurance will pay 100% beyond the maximum for the rest of the year Formulary—what Rx covered or not by the insurance HMO/EPO o if you go out of network the insurance will pay nothing so stay in your network o But in hospital--- the surgeon could be in network so $ o The anesthesiologist is not in network so $$$--- if this happen can file the appeal PPO o insurance will cover wherever you go Need to see specialist--- have to get the referral from the physician...