Health Insurance - Deductible, Copay, Coinsurance & OOPM

Activity Description

In this activity, students will explore key health insurance concepts through a real-world scenario. They'll be guided through an example of a health insurance policy and calculate costs for different medical events over a year. The activity covers critical terminologies used in health insurance - including premium, deductible, copay, coinsurance, and out-of-pocket maximum (OOPM), ensuring students understand how costs are distributed between the individual and the insurance provider.

Activity Structure:

• Students are given a scenario with details of a health insurance policy, including the premium, deductible, copay, coinsurance, and OOPM.
• They are then presented with a series of medical events (e.g., doctor visits, hospital stays) that occur throughout the year.
• For each event, students will calculate:
• Deductible paid: How much of the deductible is applied.
• Copay: The fixed amount paid for the event.
• Coinsurance: The percentage of costs paid after the deductible.
• Insurance coverage: The amount the insurance company pays.
• Out-of-pocket tracking: How close they are to the OOPM.

This activity provides a practical, hands-on way to teach students how insurance policies work, preparing them for informed financial decision-making.

Learning Objective

Students will learn and become familiar with key terms used in health insurance, including copayment (copay), coinsurance, deductible, out-of-pocket maximum (OOP maximum), and how these terms relate to each other. Students will apply their knowledge of insurance policy terms to determine how different types of expenses (e.g., doctor visits, prescriptions, hospitalizations) are covered under the insurance plan and how cost sharing is distributed between the insured individual and the insurance company.

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