Types of Private Health Insurance
Plans
Plans
Obtained through an organization such as an employer, a union, or professional organization.
Group Insurance
Categories of people covered.
Persons 65 years and older
Disabled individuals entitled to Social Security
People with end staged renal disease
Who qualify for Medicaid?
Low income elderly
Blind
Disabled receiving Supplemental Security Income
Pregnant Women
Children in low income families
Services are provided as a set of identifiable and individually distinct units of services, which are billed separately.
Fee for Service
The amount you pay every month for health insurance.
Premium
Large employers assume the risk by budgeting funds to pay medical claims incurred by their employees.
Self Insurance
Example of Hospital Insurance Part A benefit.
Hospitalization
Skilled Nursing Facility
Home Health Care
Hospice
Who funds Medicaid?
Federal government provides matching funds to each state based on per capita income.
Package pricing, a number of related services are included in one price.
Bundle Payments
The amount of money that a policyholder must pay before a health insurance policy pays a benefit.
Deductible
Directly purchased from insurer rather than employer.
Individual Private Insurance
Example of Supplementary Part B
Ambulance, ER
Physician
Diagnostic tests, radiology, pathology
Additional federal matching funds to states to expand Medicaid eligibility to children up to 19 who otherwise would not qualify because their families income exceeds the Medicaid threshold levels.
Children's Health Insurance Program (CHIP)
PPO establish fee schedules based on discounts negotiated with participating providers.
Reimbursement under managed care.
The dollar amount that the insured must pay out of pocket each time health services are received after the deductible amount has been paid.
Copayment
Offered by health maintenance organizations.
Managed Care Plans
Prescription Drug Coverage Part D
Available to those who qualify for A/B
2 choices of drug plans
Premiums vary by income
Inadequate reimbursement for providers. Therefore, some providers do not serve Medicaid covered patients.
Downfall of the Medicaid Insurance Plan
When costs are directly related to length of stay and services rendered.
Retrospective Reimbursement Rates
The proportion of cost sharing between the insurance plan and the insured. (80:20)
Coinsurance
Consumer driven health plans. Low premium. Gives consumers greater control.
High Deductible Health Plans
Special way of caring for people who are terminally ill, and for their family.
Hospice
The government owns and operates healthcare facilities, as well as employs healthcare workers, in what type of healthcare model.
What is socialized healthcare.
What country spends more on healthcare than Japan, Germany, France, China, the UK, Italy, Canada, Brazil, Spain and Australia combined?
The United States of America.
The provider is paid a set monthly fee per enrollee and required to provide all needed services within the set amount.
Capitation