Paying for Health Care

1
Paying for Health Care

• Insurance
• Medicare and Medicaid
• Managed Care
• Workers Compensation
• Military Health Care

2
Insurance

• Vocabulary
• Co-payment The part of a fee an insured person
  pays for medical services
• Insurance premium The amount paid by a
  subscriber to an insurance company
• Deductible the amount of money an insured
  person must pay for services before an insurance
  company will pay for the cost of services provided

3
Insurance

• Group insurance Employers offer coverage to
  employee
• People not covered under a group policy can
  purchase individual policies. These policies
  usually cost more than group insurance
• Insurance company decides what medical services
  will be covered.

4
Medicare and Medicaid

• Programs are result of federal legislation.
• Programs target people who lack access to care.
• Medicare began paying hospitals a flat fee for
  diagnostic related groups (DRGs)

5
Medicare

• Largest health insurance program in the nation.
• Must be at least 65 years old or disabled to
  qualify.
• Part A provides for hospital care, limited
  skilled nursing facility services, home health
  services, and hospice care.

6
Medicaid

• Government insurance for certain low-income
  people.
• Dental coverage may be available.
• No co-payment or deductible.

7
Managed Care

• Health care plans specifically designed to
  control costs.
• Advantages
• Most include preventive care, such as annual
  physicals, mammograms, and well-baby care.
• Monthly premiums and out-of-pocket expenses are
  usually lower than with traditional insurance.
• Reduced paperwork.

8
Managed Care

• Disadvantages
• Limited choice of doctors and hospitals, except
  for emergency treatment.
• Must be referred to specialist by primary care
  physician.
• Usually more restrictive than ordinary insurance.
• Not all health expenses count toward deductible.

9
Health Maintenance Organizations

• Focus on prevention and wellness.
• Businesses or individuals pay premiums to the HMO
  instead of an insurance company.
• HMOs focus on wellness care not usually covered
  by insurance.
• Popular in the 1980s and 1990s.

10
Workers Compensation

• Insurance that covers accidents, injuries, or
  diseases that occur in the workplace.
• Federal law requires businesses to purchase and
  maintain a minimum amount of workers
  compensation insurance.

11
Military Health Care

• Provided to current military personnel, retired
  military personnel, and veterans through
  CHAMPUS/TRICARE program.