1.03 Healthcare F inances

1. 1.03Healthcare Finances

2. Warm up Health Condition Scenarios

3. Healthcare Finances 1.03 Understand healthcare agencies, finances, and trends

4. Healthcare FinancesGovernment Funded by taxes 1.03 Understand healthcare agencies, finances, and trends

5. Healthcare FinancesGovernment • 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

6. Healthcare FinancesGovernment • Medicare Plans • A – hospital care • B – outpatient medical care • C- advantage plan • D – medication 1.03 Understand healthcare agencies, finances, and trends

7. Healthcare FinancesGovernment • 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

8. Healthcare FinancesGovernment • Medicare Plan A • Hospital insurance at no cost to most people • Coverage includes inpatient care • skilled nursing facilities • critical access hospitals • hospitals • hospice • home health 1.03 Understand healthcare agencies, finances, and trends

9. Healthcare FinancesGovernment • 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

10. Healthcare FinancesGovernment • 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

11. Healthcare FinancesGovernment • 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

12. Healthcare FinancesGovernment • 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

13. Healthcare FinancesGovernment • 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

14. Healthcare FinancesGovernment • 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

15. Healthcare FinancesGovernment • 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

16. Healthcare FinancesGovernment • Veterans Health Administration Provides healthcare services to former military personnel 1.03 Understand healthcare agencies, finances, and trends

17. Healthcare FinancesPrivatePaid for by the individual or individuals employer • 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 • http://www.youtube.com/watch?v=zixalFuN4Ow 1.03 Understand healthcare agencies, finances, and trends

18. Healthcare FinancesPrivate • 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

19. Healthcare FinancesPrivate • 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

20. Healthcare FinancesPrivate • 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

21. Healthcare FinancesPrivate CASH CASH CASH CASH CASH CASH CASH CASH CASH CASH 1.03 Understand healthcare agencies, finances, and trends

22. Healthcare FinancesPrivate • Out of pocket • Cost is usually higher to out of pocket than to the insurance companies and Medicare/Medicaid 1.03 Understand healthcare agencies, finances, and trends

23. Healthcare FinancesPrivate • Workers’ Compensation Pays for the healthcare of workers injured on the job Only pays a percentage of your wages- 70% http://www.comp.state.nc.us 1.03 Understand healthcare agencies, finances, and trends

24. Processing 1. Explain how a patient might be eligible for both Medicare and Medicaid benefits 2. What are some h/c costs the patient will have to pay, even with support from government finance? 3. Compare an HMO and a PPO. 4. What are some costs the patient will have to pay with private insurance? 1.03 Understand healthcare agencies, finances, and trends