Discuss the principles of different insurance plans

1. Discuss the principles of different insurance plans Objective HT03.03 Please follow along on your outline!

2. WHAT IS INSURANCE? Can I have a volunteer to look it up in the dictionary for us? Insurance plans may appear confusing at first.. but they are really pretty simple.

3. MEDICAID • Operated by the state government, benefits may vary from state to state. • Pays for the health care of people with low incomes, children or people who are disabled or blind.

4. MEDICAID

5. MEDICARE • Sponsored by the federalgovernment • Provides care for those age 65 and older.

6. Type A Covers hospital services, LTCF services or home health care after a hospitalization This type is included with medicare insurance Type B Offers additional coverage for doctors’ visits, outpatient treatments or other health care Pt. must pay extra for this type of insurance. Medicare has two parts.

7. Medicare Only pays for 80% of the cost of health care. How much does the patient have to pay?

8. WORKERS COMPENSATION insurance plan that covers workers who have been injured on the job.

9. It is administered by the stategovernment. Both the employer and the state contribute to the payments!!

10. TRICARE Formerly called CHAMPUS Provides care for the people in the military and their families.

11. Tricare is administered by the federalgovernment.

12. Managed Care • The principle is: ALL HEALTH CARE PROVIDED TO A PATIENT MUST HAVE A PURPOSE • “Quality Care at the lowest possible cost!”

13. Steps taken to create “managed care” • Second opinions • Providing preventive care • Early diagnosis • Healthy living practices

14. Three Key Terms to Know When Talking Insurance Deductibles- amount that the patient must pay “out of pocket” before the insurance plan pays anything!

15. Co-insurance • Requires that the insurance company and the patient each pay a certain part of the medical bill. • Example: 80/20 • The company pays 80% and the patient pays the other 20%

16. Co-payment • A set amount of money the patient pays for each doctor visit regardless of the tx that was given.

17. Health Care Cost • Through the roof! • The cost of HC is increasing faster than other costs of living. • In order to pay for health care- most people rely on insurance.

18. What if you don’t have insurance? It could mean financial disaster for your family. Health insurance plans are offered by several thousand insurance agencies… like Blue Cross

19. Blue Cross is a private insurance company. What does this mean?

20. Let’s look at two other forms of insurance coverage

21. HMO • The doctor must be on the list • A monthly fee is paid for membership, the fee stays the same regardless of the amount of HC used that month • Care provided is directed toward prevention

22. PPO • Preferred provider organization. • Usually provided by large companies to their employees. • The HCP will offer the company a reduced rate because of the large number of patients it will bring him!!

23. STUDY STUDY STUDY STUDY STUDY BE A WISE OLD OWL. DON”T WAIT. START NOW.