1 03 Healthcare Finances Healthcare Finances Government Finances

  • Slides: 21
Download presentation
1. 03 Healthcare Finances

1. 03 Healthcare Finances

Healthcare Finances Government Finances Private Finances 1. 03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Finances Private Finances 1. 03 Understand healthcare agencies, finances, and trends 2

Healthcare Finances Government Funded by taxes 1. 03 Understand healthcare agencies, finances, and trends

Healthcare Finances Government Funded by taxes 1. 03 Understand healthcare agencies, finances, and trends 3

Healthcare Finances Government Medicare – Pays 80% of the charges for care – Serves

Healthcare Finances Government Medicare – Pays 80% of the charges for care – Serves patients • Over age 65 • Who have received social security disability benefits for at least 2 years • With end stage renal disease 1. 03 Understand healthcare agencies, finances, and trends 4

Healthcare Finances Government Medicare Plans A – hospital care B – outpatient medical care

Healthcare Finances Government Medicare Plans A – hospital care B – outpatient medical care C- advantage plan D – medication 1. 03 Understand healthcare agencies, finances, and trends 5

Healthcare Finances Government Medicare Plan A – The original Medicare plan – Automatically enrolled

Healthcare Finances Government Medicare Plan A – The original Medicare plan – Automatically enrolled unless the patient specifically enrolls in a Medicare Advantage Plan (Part C) – Fee-for service – Pay a deductible and co-pay 1. 03 Understand healthcare agencies, finances, and trends 6

Healthcare Finances Government Medicare Plan A – Hospital insurance at no cost to most

Healthcare Finances Government Medicare Plan A – Hospital insurance at no cost to most people – Coverage includes inpatient care skilled nursing facilities critical access hospitals hospice home health 1. 03 Understand healthcare agencies, finances, and trends 7

Healthcare Finances Government Medicare Plan B – Pays for necessary medical services and supplies

Healthcare Finances Government Medicare Plan B – Pays for necessary medical services and supplies – Most people pay a premium for Plan B – Covers outpatient care doctor’s services physical or occupational therapies additional home healthcare 1. 03 Understand healthcare agencies, finances, and trends 8

Healthcare Finances Government Medicare Plan C – Combination of Part A and Part B

Healthcare Finances Government Medicare Plan C – Combination of Part A and Part B – Provided through private insurance companies approved by Medicare – Option of adding Part D – Includes HMOs PPOs Private fee-for-service plans Medicare special needs 1. 03 Understand healthcare agencies, finances, and trends 9

Healthcare Finances Government Medicare Plan D – stand-alone prescription drug coverage – most people

Healthcare Finances Government Medicare Plan D – stand-alone prescription drug coverage – most people pay a premium – plans vary and cover different drugs – can choose the best plan for patient’s needs 1. 03 Understand healthcare agencies, finances, and trends 10

Healthcare Finances Government Medigap – A private individual insurance policy that pays the difference

Healthcare Finances Government Medigap – A private individual insurance policy that pays the difference between the charges for care and the amount Medicare pays. 1. 03 Understand healthcare agencies, finances, and trends 11

Healthcare Finances Government Medicaid • Provides healthcare for: • people with low incomes •

Healthcare Finances Government Medicaid • Provides healthcare for: • people with low incomes • children who qualify for assistance • people who are disabled or blind 1. 03 Understand healthcare agencies, finances, and trends 12

Healthcare Finances Government Medicaid – Funded by federal government but regulated by individual state

Healthcare Finances Government Medicaid – Funded by federal government but regulated by individual state government – Not all people with low income qualify 1. 03 Understand healthcare agencies, finances, and trends 13

Healthcare Finances Government TRICARE Military health plan Serves: Active duty personnel and family Survivors

Healthcare Finances Government TRICARE Military health plan Serves: Active duty personnel and family Survivors of military personnel Retired military personnel 1. 03 Understand healthcare agencies, finances, and trends 14

Healthcare Finances Government Veterans Health Administration Provides healthcare services to former military personnel 1.

Healthcare Finances Government Veterans Health Administration Provides healthcare services to former military personnel 1. 03 Understand healthcare agencies, finances, and trends 15

Healthcare Finances Private Insurance – Individual insurance plan, the insured pays the total amount

Healthcare Finances 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 1. 03 Understand healthcare agencies, finances, and trends 16

Healthcare Finances Private Health Maintenance Organization (HMO) – care is directed toward prevention of

Healthcare Finances Private Health Maintenance Organization (HMO) – care is directed toward prevention of disease – patient must see only HMO approved providers – pay a monthly fee, no additional charge for care – care from non-HMO provider generally not covered 1. 03 Understand healthcare agencies, finances, and trends 17

Healthcare Finances Private Preferred Provider Organization (PPO) – Group of doctors and/or hospitals that

Healthcare Finances Private Preferred Provider Organization (PPO) – Group of doctors and/or hospitals that provide care to a specific group – PPO provides services to the insured at a reduced rate – Usually require a deductible and a co-pay – Less coverage for treatment provided by non. PPO provider 1. 03 Understand healthcare agencies, finances, and trends 18

Healthcare Finances Private Indemnity Plan ־ Traditional plan with freedom to visit physician of

Healthcare Finances Private Indemnity Plan ־ Traditional plan with freedom to visit physician of choice ־ No referral required by insurance company ־ Pay “up front” ־ Get reimbursed amount allowed by insurance policy; amounts may vary 1. 03 Understand healthcare agencies, finances, and trends 19

Healthcare Finances Private CASH Out of pocket CASH CASH CASH 1. 03 Understand healthcare

Healthcare Finances Private CASH Out of pocket CASH CASH CASH 1. 03 Understand healthcare agencies, finances, and trends 20

Healthcare Finances Private Workers’ Compensation Pays for the healthcare of workers injured on the

Healthcare Finances Private Workers’ Compensation Pays for the healthcare of workers injured on the job http: //www. comp. state. nc. us 1. 03 Understand healthcare agencies, finances, and trends 21