1.03 healthcare finances - alamance-burlington school system€¦ · healthcare finances private...

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1.03 Healthcare Finances

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Page 1: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03Healthcare Finances

Page 2: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare Finances

Government Finances

Private Finances

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Page 3: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare FinancesGovernment

Funded by taxes

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Page 4: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

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

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Page 5: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

Medicare Plans

A – hospital care

B – outpatient medical care

C- advantage plan

D – medication

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Page 6: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

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

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Page 7: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

Medicare Plan A– Hospital insurance at no cost to

most people– Coverage includes inpatient care

skilled nursing facilitiescritical access hospitalshospitals hospice home health

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Page 8: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

Medicare Plan B– Pays for necessary medical

services and supplies– Most people pay a premium for

Plan B– Covers

outpatient caredoctor’s servicesphysical or occupational therapiesadditional home healthcare

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Page 9: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

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

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Page 10: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

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

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Page 11: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

Medigap

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

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Page 12: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

Medicaid• Provides healthcare for:

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

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Page 13: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

Medicaid– Funded by federal

government but regulated by individual state government

– Not all people with low income qualify

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Page 14: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

TRICAREMilitary health plan

Serves:

Active duty personnel and family

Survivors of military personnelRetired military personnel

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Page 15: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesGovernment

Veterans Health Administration

Provides healthcare services

to former military personnel

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Page 16: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesPrivate

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

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Page 17: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

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

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Page 18: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

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

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Page 19: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesPrivate

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

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Page 20: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesPrivate

Out of pocket

CASH

CASHCASHCASHCASH

CASH

CASH

CASH

CASH

CASH

CASH

CASHCASH

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Page 21: 1.03 Healthcare finances - Alamance-Burlington School System€¦ · Healthcare Finances Private Private Insurance – Individual insurance plan, the insured pays the total ... and

1.03 Understand healthcare agencies, finances, and trends

Healthcare F inancesPrivate

Workers’ Compensation

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

Pays for the healthcare of workers injured on the job

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