UnitedHealthcare Catastrophic Compass Plus 6600 Single Adult Age 22 - Monthly premium $160 - Deductible $6,600 - Out-of-pocket maximum $6,600 Copayment Primary doctor - $50 Copayment Specialist Doctor $100 Emergency Room - No charge after deductible Hospital Services - No charge after deductible Lab Services - No charge after deductible Monthly premium Maximum out-of-pocket $ $ 160 6,600 Co-Ins Primary doctor Other doctors Emergency room Hospital services Type Deductible Co-Pay A $ 0 $ B $ 0 $ C $ 6,600 $ D $ 6,600 $ 50 100 0 0 0% 0% Total Premium Expense Total Medical Payments Total Medical Cost Payment Claim towards Type Amount Copayment Deductible Coinsurance Potential Cost to Insured Cost after limit to MAX out-of- Pocket Month Description A C $ $ January March April May May June June 80 1707 366 80 545 Primary Doctor Emergency Room & Lab tests Dermatologist office visit Primary Doctor Urologist office visit Primary Doctor Eye Doctor exam Primary Doctor Physical Therapist office visit Primary Doctor 175 250 August December 80 Totals UnitedHealthcare Catastrophic Compass Plus 6600 Single Adult Age 22 - Monthly premium $160 - Deductible $6,600 - Out-of-pocket maximum $6,600 Copayment Primary doctor - $50 Copayment Specialist Doctor $100 Emergency Room - No charge after deductible Hospital Services - No charge after deductible Monthly premium Maximum out-of-pocket $ $ 160 6,600 Co-ins Primary doctor Other doctors Emergency room I Hospital services Type Deductible Co-Pay A $ - $ 50 B $ - $ 100 C $ 6,600 $ - D $ 6,600 $ - Total Premium Expense Total Medical Payments Total Medical Cost Payment Potential Claim towards Cost to Type Amount Copaymen Deductib oinsuranc Insured Cost after limit to MAX Month Description January February February February March April May May June Primary Doctor Cardiologist Office visit Urologist Office Visit Primary Doctor Emergency Room & Lab tests Dermatologist office visit Primary Doctor Urologist office visit Primary Doctor Eye Doctor exam Primary Doctor Physical Therapist office visit Physical Therapist office visit Surgery & Hospital stay Primary Doctor Emergency Room & CT scan Primary Doctor A B B A C B A B A B A B B D A C A $ 80 $ 251 $ 147 $ 93 $ 1,707 $ 366 $ 80 $ 545 $ 80 $ 175 $ 80 $ 250 $ 420 $ 53,816 $ 133 $ 4,300 $ 80 August September October December December December Totals UnitedHealthcare Gold Compass Plus 500 Single Male Age 22 - Monthly premium $230 - Deductible $500 - Out-of-pocket Maximum $6,600 Copayment Primary doctor - $20 Copayment Other Doctor- $40 Co-Payment Emergency Room - $250 Co-Insurance Emergency Room - 20% after deductible Hospital Services -20% coinsurance after deductible Monthly premium Maximum out-of-pocket $ $ 230 6,600 Co-Ins Primary doctor Other doctors Emergency room Hospital services Type Deductible Co-Pay A $ - $ B $ - $ C $ 500 $ D $ 500 $ 20 40 250 - 20% 20% Total Premium Expense Total Medical Payments Total Medical Cost Payment Claim towards Type Amount Copayment Deductible Coinsurance Potential Cost to Insured Cost after limit to MAX out-of- Pocket Month Description A C B $ $ $ 80 1,707 366 80 January March April May May June June July August December 545 Primary Doctor Emergency Room & Lab tests Dermatologist office visit Primary Doctor Urologist office visit Primary Doctor Eye Doctor exam Primary Doctor Physical Therapist office visit Primary Doctor 80 175 80 250 80 A $ Totals UnitedHealthcare Gold Compass Plus 500 Single Adult Age 22 - Monthly premium $230 - Deductible $500 - Out-of-pocket Maximum $6,600 Copayment Primary doctor - $20 Copayment Specialist - $40 Co-Payment Emergency Room - $250 plus cost of service up to deductible Co-Insurance Emergency Room - 20% after deductible Monthly premium Maximum out-of-pocket $ 230 $ 6,600 Co-Ins Primary doctor Other doctors Emergency room Hospital services Type Deductible Co-Pay A $ - $ 20 B $ - $ 40 C $ 500 $ 250 D $ 500 $ - 20% 20% Total Premium Expense Total Medical Payments Total Medical Cost Payment Potential Claim towards Cost to Type Amount Copaymen Deductib Coinsuranc Insured Month Description Cost after limit to MAX out-of- $ . January February February February March April May May June June July August September October December December December Primary Doctor Cardiologist Office visit Urologist Office Visit Primary Doctor Emergency Room & Lab tests Dermatologist office visit Primary Doctor Urologist office visit Primary Doctor Eye Doctor exam Primary Doctor Physical Therapist office visit Physical Therapist office visit Surgery & Hospital stay Primary Doctor Emergency Room & CT scan Primary Doctor A B B A C B A B A B A B B D A C A $ 80 $ 251 $ 147 $ 93 $ 1,707 $ 366 $ 80 $ 545 $ 80 $ 175 $ 80 $ 250 $ 420 $ 53,816 $ 133 $ 4,300 $ 80 Totals One Surgery Summary of Medical Costs to Insured | Alternative Scenarios No Activity Low Activity No Insurance Catastrophe Coverage Premium Coverage Summary of Gross Profit of Insurance Company Alternative Scenarios No Activity Low Activity One Surgery No Insurance Catastrophe Coverage Premium Coverage The Patient Protection and Affordable Care Act, commonly called the Affordable Care Act (ACA) or Obamacare, was signed into federal law by President Barrack Obama in March of 2010. The goals of ACA were to improve quality and affordability of health insurance coverage, reduce the number of people nationally without health insurance, and reduce the overall cost of health care. The ACA requires that everyone must have health insurance. Those who do not have health insurance as part of their employer provided benefits package must purchase health insurance on their own. Selecting the appropriate health insurance plan can be difficult, because insurance policies can be confusing and expensive. Individuals pay monthly premiums to maintain their health insurance coverage. Those who are covered under a health insurance plan save money on health-related services, like going to the doctor or having surgery. The insurance plan specifies the amount that the patient will pay for a specific service. This price is less than the price the medical provider (i.e. the doctor) charges for their services. The patient pays the specified amount to the medical provider at the time of service. The insurance company pays the difference between the actual cost of the service and the amount paid by the patient. Not all medical services are treated the same by insurance companies. Some services require the patient to pay a copay (flat amount) for the services rendered. Other services require the patient to pay a percentage (coinsurance) of the total charges for the services rendered. Finally, insurance plans limit the total amount that a person pays a year for some services. This is called a deductible. Once the deductible is reached, the insurance pays 100% of the cost of those services. When shopping for an insurance plan; a consumer should consider the plan's premiums, copays, coinsurance, and deductible amounts. Some people go to the doctor more than others. Generally, those who go to the doctor more than others benefit from plans with higher premiums and lower copay, coinsurance, and deductible amounts. Those who rarely go to the doctor, benefit from plans with higher copay, coinsurance, and deductible amounts and lower premiums. Complete the tasks in this workbook to compare different insurance plan options and the amount of medical services a consumer expects to consume impacts the insurance buying decision. UnitedHealthcare Catastrophic Compass Plus 6600 Single Adult Age 22 - Monthly premium $160 - Deductible $6,600 - Out-of-pocket maximum $6,600 Copayment Primary doctor - $50 Copayment Specialist Doctor $100 Emergency Room - No charge after deductible Hospital Services - No charge after deductible Lab Services - No charge after deductible Monthly premium Maximum out-of-pocket $ $ 160 6,600 Co-Ins Primary doctor Other doctors Emergency room Hospital services Type Deductible Co-Pay A $ 0 $ B $ 0 $ C $ 6,600 $ D $ 6,600 $ 50 100 0 0 0% 0% Total Premium Expense Total Medical Payments Total Medical Cost Payment Claim towards Type Amount Copayment Deductible Coinsurance Potential Cost to Insured Cost after limit to MAX out-of- Pocket Month Description A C $ $ January March April May May June June 80 1707 366 80 545 Primary Doctor Emergency Room & Lab tests Dermatologist office visit Primary Doctor Urologist office visit Primary Doctor Eye Doctor exam Primary Doctor Physical Therapist office visit Primary Doctor 175 250 August December 80 Totals UnitedHealthcare Catastrophic Compass Plus 6600 Single Adult Age 22 - Monthly premium $160 - Deductible $6,600 - Out-of-pocket maximum $6,600 Copayment Primary doctor - $50 Copayment Specialist Doctor $100 Emergency Room - No charge after deductible Hospital Services - No charge after deductible Monthly premium Maximum out-of-pocket $ $ 160 6,600 Co-ins Primary doctor Other doctors Emergency room I Hospital services Type Deductible Co-Pay A $ - $ 50 B $ - $ 100 C $ 6,600 $ - D $ 6,600 $ - Total Premium Expense Total Medical Payments Total Medical Cost Payment Potential Claim towards Cost to Type Amount Copaymen Deductib oinsuranc Insured Cost after limit to MAX Month Description January February February February March April May May June Primary Doctor Cardiologist Office visit Urologist Office Visit Primary Doctor Emergency Room & Lab tests Dermatologist office visit Primary Doctor Urologist office visit Primary Doctor Eye Doctor exam Primary Doctor Physical Therapist office visit Physical Therapist office visit Surgery & Hospital stay Primary Doctor Emergency Room & CT scan Primary Doctor A B B A C B A B A B A B B D A C A $ 80 $ 251 $ 147 $ 93 $ 1,707 $ 366 $ 80 $ 545 $ 80 $ 175 $ 80 $ 250 $ 420 $ 53,816 $ 133 $ 4,300 $ 80 August September October December December December Totals UnitedHealthcare Gold Compass Plus 500 Single Male Age 22 - Monthly premium $230 - Deductible $500 - Out-of-pocket Maximum $6,600 Copayment Primary doctor - $20 Copayment Other Doctor- $40 Co-Payment Emergency Room - $250 Co-Insurance Emergency Room - 20% after deductible Hospital Services -20% coinsurance after deductible Monthly premium Maximum out-of-pocket $ $ 230 6,600 Co-Ins Primary doctor Other doctors Emergency room Hospital services Type Deductible Co-Pay A $ - $ B $ - $ C $ 500 $ D $ 500 $ 20 40 250 - 20% 20% Total Premium Expense Total Medical Payments Total Medical Cost Payment Claim towards Type Amount Copayment Deductible Coinsurance Potential Cost to Insured Cost after limit to MAX out-of- Pocket Month Description A C B $ $ $ 80 1,707 366 80 January March April May May June June July August December 545 Primary Doctor Emergency Room & Lab tests Dermatologist office visit Primary Doctor Urologist office visit Primary Doctor Eye Doctor exam Primary Doctor Physical Therapist office visit Primary Doctor 80 175 80 250 80 A $ Totals UnitedHealthcare Gold Compass Plus 500 Single Adult Age 22 - Monthly premium $230 - Deductible $500 - Out-of-pocket Maximum $6,600 Copayment Primary doctor - $20 Copayment Specialist - $40 Co-Payment Emergency Room - $250 plus cost of service up to deductible Co-Insurance Emergency Room - 20% after deductible Monthly premium Maximum out-of-pocket $ 230 $ 6,600 Co-Ins Primary doctor Other doctors Emergency room Hospital services Type Deductible Co-Pay A $ - $ 20 B $ - $ 40 C $ 500 $ 250 D $ 500 $ - 20% 20% Total Premium Expense Total Medical Payments Total Medical Cost Payment Potential Claim towards Cost to Type Amount Copaymen Deductib Coinsuranc Insured Month Description Cost after limit to MAX out-of- $ . January February February February March April May May June June July August September October December December December Primary Doctor Cardiologist Office visit Urologist Office Visit Primary Doctor Emergency Room & Lab tests Dermatologist office visit Primary Doctor Urologist office visit Primary Doctor Eye Doctor exam Primary Doctor Physical Therapist office visit Physical Therapist office visit Surgery & Hospital stay Primary Doctor Emergency Room & CT scan Primary Doctor A B B A C B A B A B A B B D A C A $ 80 $ 251 $ 147 $ 93 $ 1,707 $ 366 $ 80 $ 545 $ 80 $ 175 $ 80 $ 250 $ 420 $ 53,816 $ 133 $ 4,300 $ 80 Totals One Surgery Summary of Medical Costs to Insured | Alternative Scenarios No Activity Low Activity No Insurance Catastrophe Coverage Premium Coverage Summary of Gross Profit of Insurance Company Alternative Scenarios No Activity Low Activity One Surgery No Insurance Catastrophe Coverage Premium Coverage The Patient Protection and Affordable Care Act, commonly called the Affordable Care Act (ACA) or Obamacare, was signed into federal law by President Barrack Obama in March of 2010. The goals of ACA were to improve quality and affordability of health insurance coverage, reduce the number of people nationally without health insurance, and reduce the overall cost of health care. The ACA requires that everyone must have health insurance. Those who do not have health insurance as part of their employer provided benefits package must purchase health insurance on their own. Selecting the appropriate health insurance plan can be difficult, because insurance policies can be confusing and expensive. Individuals pay monthly premiums to maintain their health insurance coverage. Those who are covered under a health insurance plan save money on health-related services, like going to the doctor or having surgery. The insurance plan specifies the amount that the patient will pay for a specific service. This price is less than the price the medical provider (i.e. the doctor) charges for their services. The patient pays the specified amount to the medical provider at the time of service. The insurance company pays the difference between the actual cost of the service and the amount paid by the patient. Not all medical services are treated the same by insurance companies. Some services require the patient to pay a copay (flat amount) for the services rendered. Other services require the patient to pay a percentage (coinsurance) of the total charges for the services rendered. Finally, insurance plans limit the total amount that a person pays a year for some services. This is called a deductible. Once the deductible is reached, the insurance pays 100% of the cost of those services. When shopping for an insurance plan; a consumer should consider the plan's premiums, copays, coinsurance, and deductible amounts. Some people go to the doctor more than others. Generally, those who go to the doctor more than others benefit from plans with higher premiums and lower copay, coinsurance, and deductible amounts. Those who rarely go to the doctor, benefit from plans with higher copay, coinsurance, and deductible amounts and lower premiums. Complete the tasks in this workbook to compare different insurance plan options and the amount of medical services a consumer expects to consume impacts the insurance buying decision