INSTITUTIONS
These institutions receive federal, state, and local tax exemptions in exchange for providing a community benefit.
What are voluntary nonprofit institutions?
These types of providers have contracts with managed care plans.
What are Doctors and Hospitals?
Patients pay for their healthcare with their own money out of pocket.
What is direct payment?
This is the proper term for somebody eligible for medicare.
What are geriatrics?
Provides health care coverage for geriatrics (ages 65 and older) regardless of income or wealth.
What is Medicare?
These institutions are for-profit that are usually owned by corporations.
What are proprietary institutions?
This health insurance plan is a combination of the characteristics of a HMO plan and a PPO Plan.
What is a POS Plan?
A type of health insurance coverage that is obtained directly by an individual or through an employer.
What is private insurance?
These types of people are covered under Medicaid.
What are people with low-income, disabilities, etc?
One contracted with the health insurance company to provide services to plan members (providers in the plan).
What is In Network
These institutions are public and receive most of its funding from local, state, or federal sources.
What are government institutions?
This health insurance plan allows patients to receive care from a non plan provider but they are required to pay a higher out of pocket price.
What is a PPO Plan?
A healthcare plan funded by a government agency. Includes Medicare and Medicaid.
What is a government plan?
Medicaid was established in 1965 as a part of this act.
What is the Social Security Act?
An Insurance company determining whether or not a certain procedure is necessary, usually depending on money they will decide if they will pay for it.
What is Pre- Authorization?
These are some examples of community services that facilities provide, regardless of their funding.
What is emergency room treatment, community health education classes and materials, health screening services, clinical services, medical education for physicians, etc.?
This managed care plan is where services are covered only if you go to doctors, specialists, or hospitals in the plan's network (except in an emergency). *DOUBLE JEOPARDY*
What is a EPO Plan?
Most Americans obtain health insurance through this.
What is their place of employment?
This is what Medicare Part C contains.
What is inpatient care, outpatient care, and Medicare Advantage plans?
Puts health care providers in the position of managing a patient's use of health care.
What is Managed Care?
List some examples of government institutions.
What are military treatment facilities, Veterans Affairs hospitals, Public or government-funded hospitals, State mental hospitals, State rehabilitation facilities, etc.?
This health insurance plan only covers care that is delivered by a member of the plan's hospital, physician, or pharmacy panel.
What is a HMO Plan?
These are the three methods for health care payment.
What is private insurance, direct payment, and government plans?
Medicare converted to this system in 1983, and it pays the provider a fixed amount based on diagnosis or specific procedure rather than the actual cost of hospitalization/care.
What is a prospective payment system?
Aims to create an affordable health care system for all Americans. *DOUBLE JEOPARDY*
What is Health Care Cost Containment?