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1.03 Healthcare F inances. Healthcare Finances. Healthcare Finances Government. Funded by taxes. Healthcare F inances 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

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1.03 Healthcare F inances


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    1. 1.03Healthcare Finances

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

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

    4. 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

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

    6. 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

    7. 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

    8. 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

    9. 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

    10. 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

    11. 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

    12. 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

    13. 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

    14. 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

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

    16. Journal prompt…. • students answer these questions on the back of the handout or in their notebooks. • Explain how a patient might be eligible for both Medicare and Medicaid benefits. • What are some healthcare costs the patient will have to pay, even with support from government finance?

    17. Healthcare FinancesPrivate • 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

    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 • Out of pocket CASH CASH CASH CASH CASH CASH CASH CASH 1.03 Understand healthcare agencies, finances, and trends

    22. Healthcare FinancesPrivate • 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

    23. Journal prompt… • answer these questions on the back of the handout or in their notebooks. • Compare an HMO and a PPO. • What are some costs the patient will have to pay?

    24. Math Handout and Journal prompt… • Health Insurance Math handout. • complete the assignment as directed • What they think happens to the patient that is not able to pay for their healthcare. • Where would the patient that cannot pay go for healthcare?

    25. CompleteCrossword