General
Issues with Insurance
Medicare/Medicaid
100
A financial arrangement where you pay a company to protect yourself from potential financial losses in the future, such as damage, illness, or liability.
What Is...... INSURANCE
In exchange for monthly payments, the insurance company will cover partial/full cost of individual medical expenses
Visits, pharmaceuticals, procedures, etc.
Where to get Insurance?
Employers, Government Insurance, Private Insurers
100
The group of doctors, hospitals, clinics, specialists, and other healthcare providers that your insurance company has contracted.
What is a... NETWORK
This provides medical care to its members at pre-negotiated, often lower, rates.
100
This is a federal health insurance program for people 65 and over
What is Medicare?
200
The regular (generally monthly) payment you make to keep your health insurance coverage active.
What is a........ PREMIUM
200
An increase in your bill after these doctor visits because they’re not part of your insurer’s approved group of providers.
What is an...... OUT-OF-NETWORK PROVIDER
Healthcare facilities that do not have a contract with your insurance company to provide services at negotiated rates.
This may vary in cases such as health care plan, emergencies, referrals/prior authorizations etc.
200
Low income individuals, pregnant women, and individuals with disabilities qualify for this program
What is Medicaid?
300
This is the yearly amount you must pay out-of-pocket before your health insurance begins to contribute to covering services
What is a....... DEDUCTIBLE
The amount you must pay in medical care before your insurance begins to share costs.
(Does not include co-pays or premiums)
300
Would you jump off a cliff?..... If insurance has your back?
This is known as MORAL HAZARD
A concept that when individuals are protected from financial consequences, they may take more risks or behave differently.
This can be bad for the insurer and policyholders
300
Oklahoma administers Medicaid through this program
What is SoonerCare?
400
Items you are responsible for regarding costs during a visit once your deductible is met.
What is... CO-PAY, CO-INSURANCE
(EXTRA: NON-INSURED PROCEDURES)
Co-pay: A fixed amount you pay for specific services, prescriptions/visits.
Co-Insurance: A percentage of the cost of covered services is split with the insurer.
Non-Covered Services: Any procedures/items not covered by insurance will be paid fully out-of-pocket
400
An individual with a more expensive Insurance.
Who is.... someone with more comorbidities/chronic illnesses/a dangerous job
This leads to the concept of ADVERSE SELECTION
400
This Medicare Part covers outpatient care, doctor and ER visits, preventative care, and lab services
What is Part B?
500
The yearly amount you spend out-of-pocket until the Insurer pays 100% of your care.
What is.... OUT-OF-POCKET MAXIMUMS
The maximum amount is the most you’ll have to pay for covered services in a policy year.
This includes deductibles and copays.
500
When only the sickest people buy health insurance, leading to skyrocketing premiums.
What is.... ADVERSE SELECTION
A concept where people with a higher risk of needing insurance are more likely to purchase it, while those with lower risk are less likely to buy coverage.
500
This Medicare Part covers inpatient care, outpatient care, prescription drugs, and vision/dental services
What is Part C?