1.03 healthcare finances - alamance-burlington school ?· healthcare finances private private...

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  • 1.03Healthcare Finances

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare Finances

    Government Finances

    Private Finances

    2

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    Funded by taxes

    3

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    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

    4

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    Medicare Plans

    A hospital care

    B outpatient medical care

    C- advantage plan

    D medication

    5

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    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

    6

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    Medicare Plan A Hospital insurance at no cost to

    most people Coverage includes inpatient care

    skilled nursing facilitiescritical access hospitalshospitals hospice home health

    7

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    Medicare Plan B Pays for necessary medical

    services and supplies Most people pay a premium for

    Plan B Covers

    outpatient caredoctors servicesphysical or occupational therapiesadditional home healthcare

    8

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    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 plansMedicare special needs

    9

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    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

    patients needs

    10

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    Medigap

    A private individual insurance policy that pays the difference between the charges for care and the amount Medicare pays.

    11

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    Medicaid Provides healthcare for:

    people with low incomes children who qualify for assistance people who are disabled or blind

    12

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    Medicaid Funded by federal

    government but regulated by individual state government

    Not all people with low income qualify

    13

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    TRICAREMilitary health plan

    Serves:

    Active duty personnel and family

    Survivors of military personnelRetired military personnel

    14

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesGovernment

    Veterans Health Administration

    Provides healthcare services to former military personnel

    15

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesPrivate

    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

    16

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesPrivate

    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

    17

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesPrivate

    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

    18

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesPrivate

    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

    19

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesPrivate

    Out of pocket

    CASH

    CASHCASHCASHCASH

    CASH

    CASH

    CASH

    CASH

    CASH

    CASH

    CASHCASH

    20

  • 1.03 Understand healthcare agencies, finances, and trends

    Healthcare FinancesPrivate

    Workers Compensation

    http://www.comp.state.nc.us

    Pays for the healthcare of workers injured on the job

    21

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