1.03 Healthcare Finances

1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Finances Private Finances 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Funded by taxes Medicare is for all patients over the age of 65, any person with a disability that has received social security for at least 2 years, or anyone with end stage renal disease. Consists of 3 kinds of coverage. Medicare pays 80% of the charges. The patient must pay the remaining charge or have another insurance policy. Medigap is an insurance policy that pays the difference between the hospital/medical charge and the amount that Medicare pays. 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medicare Pays 80% of the charges for care Serves patients Over age 65 Who have received social security disability benefits for at least 2 years With end stage renal disease Medicare is for all patients over the age of 65, any person with a disability that has received social security for at least 2 years, or anyone with end stage renal disease. Consists of 3 kinds of coverage. Medicare pays 80% of the charges. The patient must pay the remaining charge or have another insurance policy. Medigap is an insurance policy that pays the difference between the hospital/medical charge and the amount that Medicare pays. 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medicare Plans A – hospital care B – outpatient medical care C- advantage plan D – medication Medicare is for all patients over the age of 65, any person with a disability that has received social security for at least 2 years, or anyone with end stage renal disease. Consists of 3 kinds of coverage. Medicare pays 80% of the charges. The patient must pay the remaining charge or have another insurance policy. Medigap is an insurance policy that pays the difference between the hospital/medical charge and the amount that Medicare pays. 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medicare Plan A The original Medicare plan Automatically enrolled unless the patient specifically enrolls in a Medicare Advantage Plan (Part C) Fee-for service Pay a deductible and co-pay 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medicare Plan A Hospital insurance at no cost to most people Coverage includes inpatient care skilled nursing facilities critical access hospitals hospitals hospice home health 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medicare Plan B Pays for necessary medical services and supplies Most people pay a premium for Plan B Covers outpatient care doctor’s services physical or occupational therapies additional home healthcare 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medicare Plan C Combination of Part A and Part B Provided through private insurance companies approved by Medicare Option of adding Part D Includes HMOs PPOs Private fee-for-service plans Medicare special needs 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medicare Plan D stand-alone prescription drug coverage most people pay a premium plans vary and cover different drugs can choose the best plan for patient’s needs 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medigap A private individual insurance policy that pays the difference between the charges for care and the amount Medicare pays. 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medicaid Provides healthcare for: people with low incomes children who qualify for assistance people who are disabled or blind Medicaid is funded by the federal government but regulated by state governments. Benefits vary from state to state. In most states, Medicaid pays for the healthcare of people with low incomes, children who qualify for assistance, and people who are disabled or blind. Not all people with low incomes qualify. 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Medicaid Funded by federal government but regulated by individual state government Not all people with low income qualify Medicaid is funded by the federal government but regulated by state governments. Benefits vary from state to state. In most states, Medicaid pays for the healthcare of people with low incomes, children who qualify for assistance, and people who are disabled or blind. Not all people with low incomes qualify. 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government TRICARE Military health plan Serves: Active duty personnel and family Survivors of military personnel Retired military personnel U. S. government health insurance plan for all military personnel Includes active service members and their families survivors of military personnel retired military members Veterans Administration provides healthcare services to military veterans. 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Veterans Health Administration Provides healthcare services to former military personnel U. S. government health insurance plan for all military personnel Includes active service members and their families survivors of military personnel retired military members Veterans Administration provides healthcare services to military veterans. 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Private Private Insurance Individual insurance plan, the insured pays the total amount of the monthly premium Group insurance plan the insured individual and their employer share the amount of the monthly premium 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Private Health Maintenance Organization (HMO) care is directed toward prevention of disease patient must see only HMO approved providers pay a monthly fee, no additional charge for care care from non-HMO provider generally not covered 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Private Preferred Provider Organization (PPO) Group of doctors and/or hospitals that provide care to a specific group PPO provides services to the insured at a reduced rate Usually require a deductible and a co-pay Less coverage for treatment provided by non-PPO provider 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Private Indemnity Plan Traditional plan with freedom to visit physician of choice No referral required by insurance company Pay “up front” Get reimbursed amount allowed by insurance policy; amounts may vary 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Private CASH CASH Out of pocket CASH CASH CASH CASH CASH CASH CASH CASH 1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances Private Workers’ Compensation Pays for the healthcare of workers injured on the job Health insurance plan that pays for the healthcare of workers injured on the job. http://www.comp.state.nc.us 1.03 Understand healthcare agencies, finances, and trends