HEALTH CARE PAYMENT METHODS
Name the three most common health care payment methods and explain them.
1. Private insurance: Allows people to rely on their place of employment for a health insurance system.
2. Direct payment: People pay for their health care with their own money.
3. Government plans (medicare, medicaid, TRICARE, CHIP): Health care plans funded by government agencies.
How are Medicare and Medicaid funded?
Medicare: Federally
Medicaid: State and federal funding
Are referrals required in an HMO?
YES
Which plan is most like an HMO plan because of the fact it only has one network? POS or EPO?
EPO
What's the biggest difference between an HMO and a PPO plan?
An HMO has 1 network and a PPO has 2 networks.
What is the U.S. Department of Health and Human Services? Which programs fall under it?
The cabinet-level department of the Federal executive branch that touches the lives of more Americans than any other Federal agency through its involvement with the nation’s human concerns. MEDICARE, MEDICAID, OBAMACARE, CHIP, MANAGED CARE PLAN.
Why was employer sponsored health insurance born?
After World War II, the government froze wages to control inflation and employers couldn’t raise wages. They began to offer benefits like health insurance instead.
Which plan offers the most flexibility by offering 2 networks and not requiring referrals?
PPO
Does a POS plan require referrals?
YES
In which 2 plans does going to an out-of-network specialist cost more for treatment?
HMO plan and EPO plan
Name four government plans and explain them.
MEDICARE: Provides coverage for geriatrics regardless of their income or wealth.
MEDICAID: Provides coverage for low income and disabled people.
TRICARE: Provides coverage for active and retired service personnel and their dependents.
CHIP: Provides coverage for uninsured children.
What is Obamacare? What is its whole name?
The Affordable Care Act: signed into action in 2010 to expand Medicaid, protect people with preexisting conditions, and create health insurance marketplaces.
A healthy 27 year old is looking for an affordable insurance plan. Which plan would be best for him in terms of cost? (HMO, PPO, POS, EPO)
HMO
Which plan does not cover out-of network, except in the case of emergencies?
EPO
HMO, PPO, EPO, and POS are all types of what plans?
Managed care plans.
In 1960, many Americans like the elderly and poor did not have health insurance. Which year were Medicare and Medicaid created by the government?
1965
What is Fee for Service?
A traditional healthcare payment model where providers are paid for each individual test, procedure, or visit, rather than the overall outcome or quality of care.
Which plans require a referral?
HMO and POS
Which plan is usually described as a hybrid of an HMO?
POS
EPO plans offer significantly lower what compared to other plans?
Premiums
What is dual eligibility?
Someone with a qualifying disability (Social Security Disability Insurance) and low income may be eligible for Medicaid and Medicare and Medicare would pay first and Medicaid would pay the rest. Each state determines different costs to cover for Medicaid.
Marcus Chen is very sick. He is 67 years old and wants an affordable plan with 2 networks. Which plan should he choose?
POS
Drew wants lower monthly insurance costs and he is okay with seeing a primary care physician for referrals. He doesn't need out of network coverage. Which plan is best for him? HMO, PPO, POS, EPO
HMO