Healthcare Finances HS II Unit 1.03

Health Care Finances (2 Forms) Government Finance Private Finance

Government Finances Funded by Taxes Include: Medicare Medigap Medicaid Tricare VHA (Veteran Health Administration)

Medicare Government payment for healthcare for patients over 65, any person with a disability that has received social security benefits for at least 2 years, or anyone with end stage renal disease

Medicare Plans 4 Parts: A- Hospital Care B- Outpatient Medical Care C- Advantage Plan D-Medication

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

Medicare (Part A) Hospital insurance at no cost to most people Coverage includes Inpatient Care: Skilled nursing facilities Critical Access Hospitals Hospitals Hospice Home Health

Medicare (Part 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

Medicare (Plan C) Combination of Part A and Part B Provided through private insurance companies approved by Medicare Option add Part D Include: HMOS, PPOs, Private fee-for-service plans Medicare special needs

Medicare (Part 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 need

Video on Medicare (ABCD) http://www.youtube.com/watch?v=AFbuvGxoBEc

Medigap A private insurance policy that pays the difference between the medical charge and the amount that Medicare pays http://www.youtube.com/watch?annotation_id=annotation_9 16029&feature=iv&src_vid=IwMciYv5ozw&v=FzpmByegGJo

Medicaid Government payment of healthcare services for people with: low income children who qualify for services people who are disabled or blind Funded by federal government but regulated by individual state government Not all people with low income qualify

Medicaid Video http://www.youtube.com/watch?v=0LT_pc0u7sw

Tricare Military health plan that provides services for active duty personnel and their families, survivors of military personnel and retired military personnel and their families

Veterans Health Administration Provides healthcare services to anyone who served in the military

Private Finances Private Insurance Group Insurance Plan Includes The insured pays a monthly premium for insurance plan Group Insurance Plan The insured and usually their employer share the amount of the premium Includes HMOs PPOs Indemnity Plan Out of Pocket Workers’ Compensation

Health Maintenance Organization (HMO) Insurance method that focuses on prevention of disease, must see providers from an approved list 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

HMO Video http://www.youtube.com/watch?v=vyHmBRV-KgY

Preferred Provider Organization (PPO) Group of healthcare providers that provide services to a specific group, often at a reduced rate 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

PPO vs. HMO http://www.youtube.com/watch?v=aZ-JHyZ9iF4

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)

Out of Pocket Cash Medical bill that is not covered by insurance and must be paid by the patient

Worker’s Compensation Health insurance plan that pays for the healthcare of workers injured on the the job http://www.youtube.com/watch?v=UcE6GJ05W0o

Key Finance Terms Co-insurance: the percentage of the bill for services that the policy holder must pay Co-payment (co-pay): a specific amount paid by the patient for each medical service, such as a $15 for each doctor visit or each prescription filled Deductible: amount the patient must pay before the insurance starts to pay for services

Key Finance Terms Out-of-Pocket: medical bill that is covered by insurance and must be paid by the patient Premium: the periodic amount paid to an insurance company for healthcare or prescription drugs Reimbursement: amount paid to patient toward the cost of healthcare services