1. 1.03 Healthcare Finances

2. Health Insurance Plans Premium-The periodic amount paid to an insurance company for healthcare or prescription drugs Deductible-Amount the patient must pay before the insurance starts to pay 1.03 Understand healthcare agencies, finances, and trends 2

3. Co-pay-A specific amount paid by the patient for each medical service, such as $15.00 for each doctor visit or each prescription filled. Co-insurance-The percentage of the bill for services that the policy holder must pay. 1.03 Understand healthcare agencies, finances, and trends 3 Health Insurance Plans

4. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Finances Private Finances 4

5. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Funded by taxes 5

6. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicare –Pays 80% of the charges for care –Serves patients Over age 65 Over age 65 Who have received social security disability benefits for at least 2 years Who have received social security disability benefits for at least 2 years With end stage renal disease With end stage renal disease 6

7. 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 7

8. 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 8

9. 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 hospitalshospice home health 9

10. 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 10

11. 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 HMOsPPOs Private fee-for-service plans Medicare special needs 11

12. 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 12

13. 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. 13

14. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Medicaid Provides Provides healthcare for: people with low incomes children who qualify for assistance people who are disabled or blind 14

15. 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 15

16. 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 16

17. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Veterans Health Administration P rovides healthcare services to former military personnel 17

18. Health Insurance Plans offered by several thousand Insurance agencies. Examples: 1.03 Understand healthcare agencies, finances, and trends 18 Healthcare Finances Private

19. 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 19

20. 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 20

21. 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 21

22. 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 22

23. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Private Out of pocket CASH 23

24. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Private Workers’ Compensation http://www.comp.state.nc.us Pays for the healthcare of workers injured on the job 24