Notes

Health Insurance Premium is the upfront cost of maintaining health insurance coverage. Most premiums are paid on a monthly or biweekly basis. If your healthcare is provided by your employer, they will usually deduct the premium from your paycheck
A copay is a set rate you pay for prescriptions, doctor visits, and other types of care.
Coinsurance is the percentage of costs you pay after you've met your deductible.
A deductible is the set amount you pay for medical services and prescriptions before your coinsurance kicks in fully.
A deductible is a set amount you pay each year for your healthcare before your plan starts to share the costs of covered services. For example, if you have a $3,000 deductible, you have to pay $3,000 before your insurance kicks in fully.

Out-of-pocket expenses are the medical expenses you must pay yourself.
After you have spent the out-of-pocket maximum, your healthcare plan should cover 100% of eligible expenses.
Generally, the lower your monthly premiums, the more out-of-pocket expenses you will have to pay before the insurance begins to cover your bills.

How they all work together
You pay a monthly premium just to have health insurance. When you go to the doctor or the hospital, you pay either full cost for the services, or copays as outlined in your policy. Once the total amount you pay for services, not including copays, adds up to your deductible amount in a year, your insurer starts paying a larger chunk of your medical bills, typically 60% to 90%. The remaining percentage that you pay is called coinsurance.
You’ll continue to pay copays or coinsurance until you’ve reached the out-of-pocket maximum for your policy. At that time, your insurer will start paying 100% of your medical bills until the policy year ends or you switch insurance plans, whichever is first.

To help explain copays and coinsurance, here's a simplified example.
Say you have an individual plan (no dependents) with a $3,000 deductible, $50 specialist copays, 80/20 coinsurance, and a maximum out-of-pocket limit of $6,000.
You go for your annual checkup (which is free because it's a preventive service) and mention that your shoulder has been hurting. Your doctor sends you to an orthopedic specialist (for a $50 copay) to take a closer look. That specialist recommends an MRI to find out what's going on. The MRI costs $1,500. You pay the entire amount because you haven't met your deductible yet. As it turns out, you have a torn rotator cuff and need surgery to fix it. The surgery costs $7,000. You've already paid $1,500 for the MRI, so you need to pay $1,500 of the surgery bills to meet your deductible and have the coinsurance kick in. After that, your share is 20%—which, in this example, is $1,100. All in, your torn rotator cuff costs you $4,150.

What Are Out-of-Pocket Expenses and Maximums?
Out-of-pocket expenses are healthcare costs that are not covered by insurance. The out-of-pocket maximum is the maximum amount of out-of-pocket expenses you will have to pay in one year. When you reach your out-of-pocket maximum, your health insurance plan covers 100% of all covered services for the rest of the year. Any money you spend on deductibles, copays, and coinsurance counts toward your out-of-pocket maximum. However, premiums don't count.
Like deductibles, you might have two out-of-pocket limits—an individual one and a family one.

In-Network vs. Out-of-Network
In-network providers are doctors or medical facilities with which your plan has negotiated special rates. Out-of-network providers are everything else—and they are generally much more expensive.
Keep in mind that in-network doesn't necessarily mean close to where you live. You could have a North Carolina plan and see an in-network provider at the Cleveland Clinic in Ohio.

TYPES OF HEALTH INSURANCES IN THE USA
HMO (Health Maintenance Organization) insurance for low or fixed income people < 300$, limited to In-Network
PPO (Preferred Provider Organization) insurance companies > 300$ per month, unlimited to In-Network
MILITARY worked in military facilities, Tricare For life or VA
Retirement plan Any health insurance plan provided and paid by the former employer/job .
ADD-ONS:
Drug PRESCRIPTION
DENTAL VISION & HEARING (DVH)
CANCER PLAN
HEART ATTACK & STROKE

Private insurance companies

Humana
Blue cross blue shield
United health care
Wellcare
Aetna
Cigna
Care-one
Care-plus
Care-free
Anthem
Amerigroup
Amerivantage
Simply
Blue florida
AARP
Optimum
Ascension
Cintene
Molina
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What is Medicare ?
Is a government national health insurance program in the United States, It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability
Medicare covers about half or more of healthcare expenses of those enrolled up. Enrollees almost always cover most of the remaining costs by taking additional private insurance and/or by joining a public Part C or Part D Medicare health plan
For who?
*People who are 65 or older
*Certain younger people with disabilities

What’s the difference between Medicare & Medicaid?
Medicaid is a joint federal and state program that provides health coverage for some people with limited income and resources. Other people sometimes qualify for Medicaid, like:
Pregnant women
Children
Older people
People with a disability
Medicaid offers benefits, like inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and nursing home services. As an Optional benefit might offer prescription drugs.
And it provides assistance paying for Medicare premiums and other costs. If you qualify, you can have both Medicare and Medicaid
CMS :Centers for Medicare & Medicaid Services

Medicare Advantage ( Part C)

The plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services
Original Medicare
Medicare Advantage ( Part C)
-Original Medicare includes Part A and Part B.
-You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
-You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
-To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap)
-Doesn’t cover vision, hearing, and dental services..
-an alternative to Original Medicare.
-Include coverage for Part D( drug prescription)
-In most cases, you’ll need to use doctors who are in the plan’s network.
-Plans may have lower out-of-pocket costs than Original Medicare.
-Plans may offer some extra benefits that Original Medicare doesn’t cover — like DVH services, transportation, food, over the counter. Home care, telehealth, fitness

Medicare Supplement (Medigap)
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medigap) policy can help pay some of the remaining health care costs, like:
Copayments
Coinsurance
Deductibles
-You must have Medicare Part A and Part B
-You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.

A Dual Special Needs Plan is a special kind of Medicare Advantage plan. It is an all-in-one plan that combines your Medicare Part A and Part B benefits, your Medicare Part D prescription drug coverage, your Medicaid benefits and additional health benefits such as vision, dental or fitness.
They don’t pay copays nor premiums.

But which one is better and how to choose?

Medigap will help you with extra financial assistance,
Medicare Advantage - with extra benefits

-One time open enrollment ( initial enrollment period)- Under federal law, you have a six-month open enrollment period that begins three months before the month you turn 65 or as late as three months after the birthday month.. During your open enrollment period, Medigap companies must sell you a policy at the best available rate regardless of your health status, and they cannot deny you coverage.This means you can get a Medsup (Medigap) WITHOUT underwriting (answering health questions). Out of the open enrollment window you might need to answer a bunch of health related questions and qualify! to get Medigap

-AEP. annual enrollment health insurance

The annual Annual Enrollment Plan allows you to review your current Medicare plans. In other words, it is the time to compare and review different health plans available in the market. It also allows the medical beneficiaries to change their current medical plan. It usually starts on 15th October and ends on 7th December.

What can be Done During the Medicare Annual Enrollment Period?
Medicare beneficiaries can do any of the following:

Switch from one Medicare Advantage plan to another one.
Drop a current Medicare Advantage Plan and go ahead with the Medicare Original one
Switch from Medicare Original to a Medicare Advantage Plan
Select a Part D plan if you do not currently have one
Update your current medicare coverage by changing to a new plan. Now, you can do it with your existing provider to switch to a new provider. The choice is yours.
Cancel your existing Part D plan

-OEP. Medicare Open Enrollment Plan
As we saw above, AEP allows you to make amendments to your existing Medicare Advantage Plan or Part D plan. On the other hand, Medicare Open Enrollment Plan is only for those already enrolled in Medicare Advantage Plan.

Moreover, it commences on 1st January and ends on 31st March. Also, please note that it is also an annual plan like AEP.