Guided Notes
Health Insurance & Payers
Plan types (HMO, PPO, EPO, HDHP), Medicare Parts A–D and Medicare Advantage, Medicaid, coordination of benefits and reading an insurance card.
How insurance works
Slide 1 / 6A person (or their employer) pays a monthly premium. In exchange, the insurer (the 'payer') covers part of the cost of care according to the plan's benefits.
The patient still pays a share: deductible, copays and coinsurance — up to an annual out-of-pocket maximum, after which the plan pays 100% of covered in-network care.
Providers who sign a contract with a payer are 'in-network' and accept the payer's allowed amounts.