1.03 healthcare finances - alamance-burlington school system€¦ · healthcare finances private...
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1.03Healthcare Finances
1.03 Understand healthcare agencies, finances, and trends
Healthcare Finances
Government Finances
Private Finances
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1.03 Understand healthcare agencies, finances, and trends
Healthcare FinancesGovernment
Funded by taxes
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
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
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
Medicare Plans
A – hospital care
B – outpatient medical care
C- advantage plan
D – medication
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
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
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
Medicare Plan A– Hospital insurance at no cost to
most people– Coverage includes inpatient care
skilled nursing facilitiescritical access hospitalshospitals hospice home health
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
Medicare Plan B– Pays for necessary medical
services and supplies– Most people pay a premium for
Plan B– Covers
outpatient caredoctor’s servicesphysical or occupational therapiesadditional home healthcare
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
Medicare Plan C– Combination of Part A and Part B– Provided through private insurance
companies approved by Medicare– Option of adding Part D– Includes
HMOsPPOs Private fee-for-service plansMedicare special needs
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
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
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
Medigap
– A private individual insurance policy that pays the difference between the charges for care and the amount Medicare pays.
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
Medicaid• Provides healthcare for:
• people with low incomes• children who qualify for assistance• people who are disabled or blind
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
Medicaid– Funded by federal
government but regulated by individual state government
– Not all people with low income qualify
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
TRICAREMilitary health plan
Serves:
Active duty personnel and family
Survivors of military personnelRetired military personnel
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesGovernment
Veterans Health Administration
Provides healthcare services
to former military personnel
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesPrivate
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
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1.03 Understand healthcare agencies, finances, and trends
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
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1.03 Understand healthcare agencies, finances, and trends
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
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesPrivate
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
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesPrivate
Out of pocket
CASH
CASHCASHCASHCASH
CASH
CASH
CASH
CASH
CASH
CASH
CASHCASH
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1.03 Understand healthcare agencies, finances, and trends
Healthcare F inancesPrivate
Workers’ Compensation
http://www.comp.state.nc.us
Pays for the healthcare of workers injured on the job
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