Healthcare What?: Recent Episodes
Healthcare What?
Key Concepts In Network
Out of Network
Deductible
Copay
Coinsurance
Out of Pocket Maximum
Lifetime Maximum
The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories:
- Ambulatory Patient Services
- Prescription Drugs
- Emergency Care
- Behavioral Health Services
- Hospitalization
- Rehabilitative and Habilitative Services
- Preventive and Wellness Services
- Laboratory Services
- Pediatric Care
- Maternity and Newborn Care
Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid.
PPO – Preferred Provider Organization
HMO – Health Maintence Organization
Fee for Service
Quality/Cost Tiers
Narrow Network
ACO – Accountable Care Organization
Premium Employer
employee
subsidy
how it’s used by the insurance
carrier loss ratio
Plan type. Traditional.
HDHP
HSA
HRA.
FSA. standard Limited
Who am I? What Healthcare What is all about? Obtaining Insurance Benefits + Open enrollment + Special enrollment – Life Events: - Adoption - Foster care - Birth of a child - Marriage - Gain of citizenship, national or lawfully present status - Loss of health insurance coverage (not due to nonpayment of premium) - Newly eligible or ineligible for tax credits or having a change in eligibility for cost-sharing reductions for individuals already enrolled - Permanent address change which provides new Qualified Health Plan choices - Enrolled member of a federally recognized tribe + Employer + Individual Market - Agent/Broker + ACA exchanges