I.Affordable Care Act and You

Learning Objective: to look at different dimensions of the Affordable Care Act and the new healthcare exchanges

1. Explain some of the issues that the Affordable Care Act set out to address.

__________________________________________________________________________________________

_____________________________________________________________________________________

2. What are some positive aspects of the Affordable Care Act?

__________________________________________________________________________________________

_____________________________________________________________________________________

3. What are some of the criticisms of the Affordable Care Act?

__________________________________________________________________________________________

_____________________________________________________________________________________

4. What is the maximum amount you will pay on your taxes if you don't have any insurance for a full year?

_____________________________________________________________________________________

_____________________________________________________________________________________

5. Using the online exchange estimator (https://www.kff.org/interactive/subsidy-calculator/,or, http://www.npr.org/sections/health-shots/2013/09/30/226456791/how-much-will-obamacare-cost-me-try-our-calculator), fill out the below table assuming that you insure just yourself. Use an income of $100. List the costs for the bronze, silver, and gold levels.

Level

Estimated Monthly Premium

Estimated Deductible

Estimated Out-of-Pocket Maximum

Bronze

Silver

Gold

6. Using the online exchange estimator fill out the below table assuming that you insure a family with the following ages:34, 37, 9, and 4. For this question use your school's zip code and state.

Level

Estimated Monthly Premium

Estimated Deductible

Estimated Out-of-Pocket Maximum

Bronze

Silver

Gold

7. Using the same family as the previous question, calculate their Affordable Care Act subsidy assuming that they make $25,000 a year. Explain your results.

__________________________________________________________________________________________

__________________________________________________________________________________________

8. What would the expenses be for a single tobacco user who is 54 and living in Florida?

Level

Estimated Monthly Premium

Estimated Deductible

Estimated Out-of-Pocket Maximum

Bronze

Silver

Gold

9. What would the expenses be for a single tobacco user who is 64 and living in Florida?

Level

Estimated Monthly Premium

Estimated Deductible

Estimated Out-of-Pocket Maximum

Bronze

Silver

Gold

10. How much did changing the age alter the expected costs?

__________________________________________________________________________________________________________________________________________________________________________

11. Explain what subsidies the above individual can expect?

__________________________________________________________________________________________________________________________________________________________________________

12. What happens for the level of subsidies if the age is decreased to 54? 44? 34? Why do you think these changes occurred?

__________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________

13. What happens to an individual's healthcare options when they reach retirement age?

__________________________________________________________________________________________________________________________________________________________________________

II. What do They Pay?

Learning Objective: to be able to calculate the out of pocket cost using several basic insurance plans.

For the purpose of this assignment, we will be using the three plans shown below. Assume that all of the medical expenses occur in the same billing year--so carry over the accounts from each previous year. With each situation, calculate what the individual would owe and find the important amounts to carry over to the next event. We will also assume that a doctor's visit only costs the co-pay. The plans shown below are gross simplifications of actual insurance plans so be careful when it comes to calculating your own medical expenses.

Plan A:Everything has a $20 co-pay. The plan has a $1,000 deductible but pays 100% of expenses after that. This plan also has a yearly limit on total deductible expenses of $2,500.

Plan B:Most things have a $10 co-pay. There is a $200 deductible with 80% coinsurance after that. There is no limit on yearly out-of-pocket expenses.There is a co-pay limit of $100 for the year.

Plan C:This is a health savings account. There is a $50 co-pay for everything and the account has $40,000 in it.

1. The whole household wants to play in a family kickball league so they need to get physicals. This ends up being five visits to the doctors' office. What was paid, and what is left*? Show your work.

(*: Left is used to keep track of the yearly limits given above:total deductible limit, co-pay limit, and the amount left in the HSA.)

Paid by the planPaid by individualLeft

Plan A.

Plan B.

Plan C.

2. Kip sprains his ankle badly sliding into first base. This involves a doctor's visit along with an MRI which costs $3,000. What was paid, and what is left? Show your work.

Paid by the planPaid by individualLeft

Plan A.

Plan B.

Plan C.

2. Annalee has a baby. The total cost ends up being $15,000 along with the co-pay.

Paid by the planPaid by individualLeft

Plan A.

Plan B.

Plan C.

3. Everyone gets strep so this ends up being five doctors' visits.

Paid by the planPaid by individualLeft

Plan A.

Plan B.

Plan C.

4. Ahmed gets appendicitis. The surgery costs $12,000, but while he was in the hospital, he also got pneumonia. He had to remain hospitalized for 14 days at a cost of $200 per day. This also ends up being 3 co-pays.

Paid by the planPaid by individualLeft

Plan A.

Plan B.

Plan C.

5. Lee ends up getting a rare but treatable form of leukemia. He is hospitalized for several months and makes a full recovery. He total medical bills end up being $130,000 and one co-pay.

Paid by the planPaid by individualLeft

Plan A.

Plan B.

Plan C.

6. Summarize each plan in the table below:

Paid by the planPaid by individual

Plan A.

Plan B.

Plan C.

7. Based on your calculations discuss as a group which plan you would expect to be most and least expensive. Explain your reasoning.

_____________________________________________________________________________________

_____________________________________________________________________________________

8. How much money would this family have needed to make to sustain them through this past year under each plan? A household this size would normally spend 4-10% of their income on healthcare. Explain your reasoning.

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

9. Why do most insurance plans require individuals to pay part of the cost of medical care?

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

10. Why do you think that health care is so expensive?

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________