Paying for Health Care - PowerPoint PPT Presentation

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Paying for Health Care

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Paying for Health Care Insurance Medicare and Medicaid Managed Care Workers Compensation Military Health Care Insurance Vocabulary Co-payment: The part of a fee an ... – PowerPoint PPT presentation

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Title: Paying for Health Care


1
Paying for Health Care
  • Insurance
  • Medicare and Medicaid
  • Managed Care
  • Workers Compensation
  • Military Health Care

2
Insurance
  • Vocabulary
  • Co-payment The part of a fee an insured person
    pays for medical services
  • Insurance premium The amount paid by a
    subscriber to an insurance company
  • Deductible the amount of money an insured
    person must pay for services before an insurance
    company will pay for the cost of services provided

3
Insurance
  • Group insurance Employers offer coverage to
    employee
  • People not covered under a group policy can
    purchase individual policies. These policies
    usually cost more than group insurance
  • Insurance company decides what medical services
    will be covered.

4
Medicare and Medicaid
  • Programs are result of federal legislation.
  • Programs target people who lack access to care.
  • Medicare began paying hospitals a flat fee for
    diagnostic related groups (DRGs)

5
Medicare
  • Largest health insurance program in the nation.
  • Must be at least 65 years old or disabled to
    qualify.
  • Part A provides for hospital care, limited
    skilled nursing facility services, home health
    services, and hospice care.

6
Medicaid
  • Government insurance for certain low-income
    people.
  • Dental coverage may be available.
  • No co-payment or deductible.

7
Managed Care
  • Health care plans specifically designed to
    control costs.
  • Advantages
  • Most include preventive care, such as annual
    physicals, mammograms, and well-baby care.
  • Monthly premiums and out-of-pocket expenses are
    usually lower than with traditional insurance.
  • Reduced paperwork.

8
Managed Care
  • Disadvantages
  • Limited choice of doctors and hospitals, except
    for emergency treatment.
  • Must be referred to specialist by primary care
    physician.
  • Usually more restrictive than ordinary insurance.
  • Not all health expenses count toward deductible.

9
Health Maintenance Organizations
  • Focus on prevention and wellness.
  • Businesses or individuals pay premiums to the HMO
    instead of an insurance company.
  • HMOs focus on wellness care not usually covered
    by insurance.
  • Popular in the 1980s and 1990s.

10
Workers Compensation
  • Insurance that covers accidents, injuries, or
    diseases that occur in the workplace.
  • Federal law requires businesses to purchase and
    maintain a minimum amount of workers
    compensation insurance.

11
Military Health Care
  • Provided to current military personnel, retired
    military personnel, and veterans through
    CHAMPUS/TRICARE program.
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