Module 7 lecture, part 2 Flashcards
What are not generally included in health insurance?
Vision and dental
What percentage is covered by private insurance in the US in 2015?
56%
What are the types of private insurance?
Group insurance
Self-insurance
Individual private health insurance
Managed care plans: HMOs, PPOs
High-deductible health plans
Medicap: Medicare Supplement Insurance
How can grp insurance be obtained?
Employer
Union
Professional org
When does grp insurance have tax advantages?
When obtained through an employer
How does a self-insured plan work?
The employer, mostly large businesses, acts as its own insurer
What are some benefits of self-insurance?
No premium tax on employers
Exempt from some of the ACA requirements
In individual private health insurance, what are premiums based on?
Individual’s health and demographics
Employee Retirement Income Security Act of 1974- what are its implications?
Exempts self-insured plans from ACA requirements
In what form is most health insurance?
Managed care plans
What type of plans are high-deductible plans?
Consumer-driven
What are two types of high-deductible plans?
HRA
HSA
What does Medigap cover?
The high out of pocket costs in the original Medicare program
To whom is Medigap not available to? What does it not cover?
Those covered by Medicaid or Medicare advantage
Long-term care
What is the trend of employment-based insurance since 2000?
Continuous decrease in coverage
What percentage of private health insurance was health-based in 2005?
91.6%
What was the percentage of private health insurance that was employer-based in 2011?
89%
Trends in the uninsured
Dramatically increased between 2000 and 2009
Premium subsidies from employers have _______, while out of pocket costs have ______.
Decreased, increased
What were the increases in premiums for single and family plans between 2008-2013?
Single- 25%
Family- 29%
How much have deductibles increased in employment-based insurance between 2008-2013?
From $735 to $1000, $135 on avg
ACA compliance requirements
Coverage for young adults under 26 on their parents’ plans
Coverage for pre-existing conditions
Coverage for preventive services without cost sharing
Imposing a fee on insurers for selling plans through the exchanges
No dollar limits on benefits
Limits on out of pocket costs for deductibles and copayments/coinsurance
Required minimum medical lost ratios (MLR)
Details about MLR
MLR = % of premium revenue spent on medical expenses
The rest = administration, marketing, and profits
85% for large grp insurance plans
80% for individual/small grp insurance plans
Likely effects of MLR
Rise in premiums as a safety cushion
What are the conditions of the ACA individual mandate?
All legal residents must have “minimum essential coverage” or pay a penalty tax
Plans must include the essential health benefits in 10 categories
What are the exemptions to the ACA individual mandate?
Unaffordability
Religious opposition to insurance
Being a member of a recognized Indian tribe
Exempt from filing income taxes
A coverage gap < 3 mos
Plans purchased at the health insurance marketplace
Problems with the ACA individual mandate
The penalty tax is not strong enough
Qualifications for the subsidies is based solely on income
