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key terms to remember

Short-Term Medical

Minimum Essential Coverage

Minimum Essential Coverage

Also called temporary health insurance or term health insurance,  provides a temporary solution to help fill gaps in coverage. Consider short term if you're: Between jobs. Waiting for other coverage to begin or a Student.

Minimum Essential Coverage

Minimum Essential Coverage

Minimum Essential Coverage

 The type of health insurance policy an individual needs to meet health coverage requirements under the Patient Protection and Affordable Care Act (ACA), U.S. health reform.

Deductible

Minimum Essential Coverage

Co-Insurance

You will pay the amount before the insurance pays anything. (the amount before the co-insurance). Look for the words (after deductible) Beware of very high deductibles! 


Co-Insurance

Out of pocket max

Co-Insurance

The Split between the insurance company and you.  Ex. 80/20 means the insurance company pays 80% and you the insured pays the 20% until you reach your out of pocket max. 

Out of pocket max

Out of pocket max

Out of pocket max

The Total Amount of money you will pay out of your pocket during a Plan cycle.  Includes your deductible. 

Co-pay

Out of pocket max

Out of pocket max

A specific dollar amount that you will pay at the time of visit. 

EXample: How your plan works

Susan is 25 and feels really sick, She has a fever, lost the sense of taste!!! She goes to the hospital and is diagnosed with COVID-19. She is hospitalized for 5 day. 


The Bill: $35,000


Her Health Plan: $5,000 Deductible: Co-Insurance 50/50, Out of Pocket Max 5,000 after deductable


The Break Down

$35,000 - $5,000 (she pays the first $5,000 which is her deductible)


$30,000 is left

Now your coinsurance is 50/50 until she reaches another $5,000

=$25,000 The insurance company pays

=$5,000 You pay


Total paid by Insurance = $25,000

Total Paid by you = $10,000


Lesson: You may have to use your insurance, so don't choose a high deductible to save $10 per month. It's not worth it in the end.


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