1. Paying for Health Care Insurance Medicare and Medicaid Managed Care Workers’ Compensation Military Health Care

2. Insurance Vocabulary Vocabulary Co-payment: The part of a fee an insured person pays for medical services Co-payment: The part of a fee an insured person pays for medical services Insurance premium: The amount paid by a subscriber to an insurance company Insurance premium: The amount paid by a subscriber to an insurance company Deductible: the amount of money an insured person must pay for services before an insurance company will pay for the cost of services provided Deductible: the amount of money an insured person must pay for services before an insurance company will pay for the cost of services provided

3. Insurance Group insurance: Employers offer coverage to employee Group insurance: Employers offer coverage to employee People not covered under a group policy can purchase individual policies. These policies usually cost more than group insurance People not covered under a group policy can purchase individual policies. These policies usually cost more than group insurance Insurance company decides what medical services will be covered. Insurance company decides what medical services will be covered.

4. Medicare and Medicaid Programs are result of federal legislation. Programs are result of federal legislation. Programs target people who lack access to care. Programs target people who lack access to care. Medicare began paying hospitals a flat fee for diagnostic related groups (DRGs) Medicare began paying hospitals a flat fee for diagnostic related groups (DRGs)

5. Medicare Largest health insurance program in the nation. Largest health insurance program in the nation. Must be at least 65 years old or disabled to qualify. Must be at least 65 years old or disabled to qualify. Part A provides for hospital care, limited skilled nursing facility services, home health services, and hospice care. Part A provides for hospital care, limited skilled nursing facility services, home health services, and hospice care.

6. Medicaid Government insurance for certain low- income people. Government insurance for certain low- income people. Dental coverage may be available. Dental coverage may be available. No co-payment or deductible. No co-payment or deductible. INDIANA MEDICAID AND OTHER MEDICAL ASSISTANCE PROGRAMS 100341842799 001 Danny L. Owens 07/19/62

7. Managed Care Health care plans specifically designed to control costs. Health care plans specifically designed to control costs. Advantages Advantages Most include preventive care, such as annual physicals, mammograms, and well- baby care. Most include preventive care, such as annual physicals, mammograms, and well- baby care. Monthly premiums and out-of-pocket expenses are usually lower than with traditional insurance. Monthly premiums and out-of-pocket expenses are usually lower than with traditional insurance. Reduced paperwork. Reduced paperwork.

8. Managed Care Disadvantages Disadvantages Limited choice of doctors and hospitals, except for emergency treatment. Limited choice of doctors and hospitals, except for emergency treatment. Must be referred to specialist by primary care physician. Must be referred to specialist by primary care physician. Usually more restrictive than ordinary insurance. Usually more restrictive than ordinary insurance. Not all health expenses count toward deductible. Not all health expenses count toward deductible.

9. Health Maintenance Organizations Focus on prevention and wellness. Focus on prevention and wellness. Businesses or individuals pay premiums to the HMO instead of an insurance company. Businesses or individuals pay premiums to the HMO instead of an insurance company. HMOs focus on wellness care not usually covered by insurance. HMOs focus on wellness care not usually covered by insurance. Popular in the 1980s and 1990s. Popular in the 1980s and 1990s.

10. Workers’ Compensation Insurance that covers accidents, injuries, or diseases that occur in the workplace. Insurance that covers accidents, injuries, or diseases that occur in the workplace. Federal law requires businesses to purchase and maintain a minimum amount of workers’ compensation insurance. Federal law requires businesses to purchase and maintain a minimum amount of workers’ compensation insurance.

11. Military Health Care Provided to current military personnel, retired military personnel, and veterans through CHAMPUS/TRICARE program. Provided to current military personnel, retired military personnel, and veterans through CHAMPUS/TRICARE program.