Transcript Health Care Finances

1.03
Healthcare Finances
Healthcare Finances
Government
Finances
Private
Finances
1.03 Understand healthcare agencies,
finances, and trends
2
Healthcare Finances
Government
Funded by taxes
1.03 Understand healthcare agencies,
finances, and trends
3
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
1.03 Understand healthcare agencies,
finances, and trends
4
Healthcare Finances
Government
Medicare Plans
A – hospital care
B – outpatient medical care
C- advantage plan
D – medication
1.03 Understand healthcare agencies,
finances, and trends
5
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
6
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
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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
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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
9
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
10
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
11
Healthcare Finances
Government
Medicaid
• Provides healthcare for:
• people with low incomes
• children who qualify for assistance
• people who are disabled or blind
1.03 Understand healthcare agencies,
finances, and trends
12
Healthcare Finances
Government
Medicaid
– Funded by federal
government but
regulated by
individual state
government
– Not all people with
low income qualify
1.03 Understand healthcare agencies,
finances, and trends
13
Healthcare Finances
Government
TRICARE
Military health plan
Serves:
Active duty personnel and family
Survivors of military personnel
Retired military personnel
1.03 Understand healthcare agencies,
finances, and trends
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Healthcare Finances
Government
Veterans Health Administration
Provides healthcare services
to former military personnel
1.03 Understand healthcare agencies,
finances, and trends
15
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
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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
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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 nonPPO provider
1.03 Understand healthcare agencies,
finances, and trends
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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
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Healthcare Finances
Private
CASH
Out of pocket
CASH
CASH
CASH
CASH
CASH
CASH
CASH
CASH
CASH
1.03 Understand healthcare agencies,
finances, and trends
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Healthcare Finances
Private
Workers’ Compensation
Pays for the healthcare of
workers injured on the job
http://www.comp.state.nc.us
1.03 Understand healthcare agencies,
finances, and trends
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