Transcript
Page 1: 1.03 Healthcare Finances. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Finances Private Finances 2

1.031.03Healthcare FinancesHealthcare Finances

Page 2: 1.03 Healthcare Finances. 1.03 Understand healthcare agencies, finances, and trends Healthcare Finances Government Finances Private Finances 2

1.03 Understand healthcare agencies, 1.03 Understand healthcare agencies, finances, and trendsfinances, and trends

Healthcare FinancesHealthcare Finances

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1.03 Understand healthcare agencies, 1.03 Understand healthcare agencies, finances, and trendsfinances, and trends

Healthcare FinancesHealthcare FinancesGovernmentGovernment

Funded by taxesFunded by taxes

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1.03 Understand healthcare agencies, 1.03 Understand healthcare agencies, finances, and trendsfinances, and trends

Healthcare FinancesHealthcare FinancesGovernmentGovernment

MedicareMedicare– Pays 80% of the charges for carePays 80% of the charges for care– Serves patientsServes patients

• Over age 65Over age 65• Who have received social security disability Who have received social security disability

benefits for at least 2 yearsbenefits for at least 2 years• With end stage renal diseaseWith end stage renal disease

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1.03 Understand healthcare agencies, 1.03 Understand healthcare agencies, finances, and trendsfinances, and trends

Healthcare FinancesHealthcare FinancesGovernmentGovernment

Medicare Plans Medicare Plans

A – hospital careA – hospital care

B – outpatient medical careB – outpatient medical care

C- advantage planC- advantage plan

D – medicationD – medication

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Healthcare FinancesHealthcare FinancesGovernmentGovernment

Medicare Medicare Plan APlan A– The original Medicare planThe original Medicare plan– Automatically enrolled Automatically enrolled

unless the patient unless the patient specifically enrolls in a specifically enrolls in a Medicare Advantage Plan Medicare Advantage Plan (Part C)(Part C)

– Fee-for serviceFee-for service– Pay a deductible and co-payPay a deductible and co-pay

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Healthcare FinancesHealthcare FinancesGovernmentGovernment

Medicare Medicare Plan APlan A– Hospital insurance at no cost to Hospital insurance at no cost to

most peoplemost people– Coverage includes inpatient careCoverage includes inpatient care

skilled nursing facilitiesskilled nursing facilities

critical access hospitalscritical access hospitals

hospitals hospitals

hospice hospice

home healthhome health

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Healthcare FinancesHealthcare FinancesGovernmentGovernment

Medicare Medicare Plan BPlan B– Pays for necessary medical Pays for necessary medical

services and suppliesservices and supplies– Most people pay a premium for Most people pay a premium for

Plan BPlan B– CoversCovers

outpatient careoutpatient care

doctor’s servicesdoctor’s services

physical or occupational therapiesphysical or occupational therapies

additional home healthcareadditional home healthcare

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1.03 Understand healthcare agencies, 1.03 Understand healthcare agencies, finances, and trendsfinances, and trends

Healthcare FinancesHealthcare FinancesGovernmentGovernment

Medicare Medicare Plan CPlan C– Combination of Combination of Part APart A and and Part BPart B– Provided through private insurance Provided through private insurance

companies approved by Medicarecompanies approved by Medicare– Option of adding Option of adding Part DPart D– IncludesIncludes

HMOsHMOs

PPOs PPOs

Private fee-for-service plansPrivate fee-for-service plans

Medicare special needsMedicare special needs

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1.03 Understand healthcare agencies, 1.03 Understand healthcare agencies, finances, and trendsfinances, and trends

Healthcare FinancesHealthcare FinancesGovernmentGovernment

Medicare Medicare Plan DPlan D– stand-alone prescription drug stand-alone prescription drug

coveragecoverage– most people pay a premiummost people pay a premium– plans vary and cover different plans vary and cover different

drugsdrugs– can choose the best plan for can choose the best plan for

patient’s needspatient’s needs

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Healthcare FinancesHealthcare FinancesGovernmentGovernment

Medigap Medigap

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

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1.03 Understand healthcare agencies, 1.03 Understand healthcare agencies, finances, and trendsfinances, and trends

Healthcare FinancesHealthcare FinancesGovernmentGovernment

MedicaidMedicaid• Provides Provides healthcare for:

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

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Healthcare FinancesHealthcare FinancesGovernmentGovernment

MedicaidMedicaid– Funded by federal Funded by federal

government but government but regulated by regulated by individual state individual state governmentgovernment

– Not all people with Not all people with low income qualifylow income qualify

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1.03 Understand healthcare agencies, 1.03 Understand healthcare agencies, finances, and trendsfinances, and trends

Healthcare FinancesHealthcare FinancesGovernmentGovernment

TRICARETRICARE

Military health planMilitary health plan

Serves:Serves:

Active duty personnel and familyActive duty personnel and family

Survivors of military personnelSurvivors of military personnel

Retired military personnelRetired military personnel

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Healthcare FinancesHealthcare FinancesGovernmentGovernment

Veterans Health AdministrationVeterans Health Administration

PProvides healthcare services rovides healthcare services

to former military personnelto former military personnel

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Journal prompt….

– students answer these questions on the back of the handout or in their notebooks.

– Explain how a patient might be eligible for both Medicare and Medicaid benefits.

What are some healthcare costs the patient will have to pay, even with support from government finance?

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Healthcare FinancesHealthcare FinancesPrivatePrivate

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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Healthcare FinancesHealthcare FinancesPrivatePrivate

Health Maintenance Organization Health Maintenance Organization (HMO)(HMO)

– care is directed toward prevention of diseasecare is directed toward prevention of disease– patient must see only HMO approved patient must see only HMO approved

providersproviders– pay a monthly fee, no additional charge for pay a monthly fee, no additional charge for

carecare– care from non-HMO provider generally not care from non-HMO provider generally not

coveredcovered

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Healthcare FinancesHealthcare FinancesPrivatePrivate

Preferred Provider Organization Preferred Provider Organization (PPO)(PPO)

– Group of doctors and/or hospitals that provide Group of doctors and/or hospitals that provide care to a specific groupcare to a specific group

– PPO provides services to the insured at a PPO provides services to the insured at a reduced ratereduced rate

– Usually require a deductible and a co-payUsually require a deductible and a co-pay– Less coverage for treatment provided by non-Less coverage for treatment provided by non-

PPO providerPPO provider

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Healthcare FinancesHealthcare FinancesPrivatePrivate

Indemnity PlanIndemnity Plan

־ Traditional plan with freedom to visit Traditional plan with freedom to visit physician of choicephysician of choice

־ No referral required by insurance companyNo referral required by insurance company־ Pay “up front”Pay “up front”־ Get reimbursed amount allowed by Get reimbursed amount allowed by

insurance policy; amounts may varyinsurance policy; amounts may vary

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Healthcare FinancesHealthcare FinancesPrivatePrivate

Out of pocketOut of pocket

CASH

CASH

CASH

CASH

CASH

CASH

CASH

CASH

CASHCASH

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Healthcare FinancesHealthcare FinancesPrivatePrivate

Workers’ CompensationWorkers’ Compensation

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

Pays for the healthcare of workers injured on the job

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Journal prompt…

answer these questions on the back of the handout or in their notebooks.– Compare an HMO and a PPO.

What are some costs the patient will have to pay?

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Math Handout and Journal prompt…

– Health Insurance Math handout.– complete the assignment as directed

– What they think happens to the patient that is not able to pay for their healthcare.

– Where would the patient that cannot pay go for healthcare?

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Complete

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