Health Insurance Basics (Part 1 of 3) | HealthiNation

Uploaded by HealthiNation on 12.04.2012

Hello, and welcome to HealthiNation. I’m Malachy Cleary.
Did you know that a leading cause of personal bankruptcy in the US is the unplanned costs
related to a serious medical condition? Even if you are doing all the right things, unexpected
illnesses or accidents can happen. Having the right type of health insurance is one
way to protect yourself. The subject of health insurance can be confusing
because of the different types of plans, payments and terms that go with it.
Health insurance is basically a safety net to make sure you can pay doctor and hospital
bills if you get sick. If that illness is unexpected or caused by an accident… those
bills can add up to many thousands of dollars. In a moment we’ll talk about insurance options
and key definitions. But, first let’s talk about who provides health insurance.
There are two main sources - the government and commercial companies.
The government is a provider of Medicare and Medicaid insurance programs. Medicare covers
people 65 years and older, and for those with disabilities. Medicaid is coverage for low-income
individuals and families who meet certain eligibility requirements.
Non-government, or commercial, insurance companies also provide coverage, usually through employers
or directly to the individual. About 60% of Americans receive their health insurance through
their employer. So, now you know who provides insurance, let’s
talk about the different types of health insurance. There are two main types, Fee for Service
plans and Managed Care plans.
Fee for service plans are also called traditional health insurance. Under these plans you typically
pay for health services, and are then reimbursed by the insurance provider for part or all
of that cost.
The more popular type of insurance in the US is Managed Care because it has been more
effective than fee-for-service insurance in keeping health care costs down. Under managed
care plans, a group of doctors and hospitals agree to work with an insurance plan at lower
rate, negotiated by the managed care organization. Doctors and hospitals who participate with
the managed care company are known as “In-Network” providers.
Types of managed care plan models include Health Maintenance Organizations (HMOs), Preferred
Provider Organizations (PPOs) and Point-of-Service plans (POSs).