1. 1.03 Healthcare Finances

2. 1.03 Understand healthcare agencies, finances, and trends
Healthcare Finances
Government Finances
Private
Finances
1.03 Understand healthcare agencies, finances, and trends

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. 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.
1.03 Understand healthcare agencies, finances, and trends