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138 Privately Funded Programs of Children and Adults.

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Presentation on theme: "138 Privately Funded Programs of Children and Adults."— Presentation transcript:

1 138 Privately Funded Programs of Children and Adults

2 139 Health Maintenance Organization (HMO) Managed Care gatekeeper. co-pay pays for all of your well and sick care out of network, you will have to pay for the care yourself.

3 140 Indemnity Plan Indemnity Plan where you can go to any doctor you’d like. only pays part of your bill. deductible Costs more that an HMO Preferred Provider Organization (PPO)

4 141 Private Mental Health Benefits Have to provide mental health services Limits of visits and low pay unless a parity (AB88) diagnosis

5 142 Private Dental Insurance Usually not part of medical insurance Need separate dental insurance

6 143 Vision Insurance Usually not part of medical insurance Need separate vision insurance

7 144 Important Points for Private Insurance There is a variety of coverage Try to get the coverage that meets your needs (if you can afford it) know what your plan covers

8 145 Private Pay No insurance and don’t qualify for publicly funded program Pay out of pocket sliding fee scale

9 146 Important Points for Private Pay Many clinics will ask for proof of your income, Call before you go to see what their requirements are Bring something like a pay stub with you

10 147 Combining Public and Private Healthcare Programs Some families may be qualified for several government and/or private insurance programs. It is okay to have both

11 148 Important Points in Combining Programs Know what services are available to you You can get help

12 149 Important Legislation

13 150 Medi-Cal Redesign New legislation to help cut the cost of Medi-Cal and make it more efficient. Will be phased in starting in January Seniors and people with disabilities will receive care through Medi-Cal managed care plans

14 151 Medi-Cal Redesign Co-pay for families over 100% FPL or people with disabilities whose income is higher than the SSI/SSP level $1000 per year limit on dental services.

15 152 AB88 – Mental Health Parity AB (assembly bill) 88 Serious mental illness or autism Can’t limit visits or pay very low rates for care.


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