Paying for Health CarePaying for Health Care

InsuranceInsuranceMedicare and MedicaidMedicare and Medicaid

Managed CareManaged CareWorkers’ CompensationWorkers’ Compensation

Military Health CareMilitary Health Care

InsuranceInsurance

VocabularyVocabularyCo-paymentCo-payment: The part of a fee an : The part of a fee an

insured person pays for medical servicesinsured person pays for medical services Insurance premiumInsurance premium: The amount paid : The amount paid

by a subscriber to an insurance by a subscriber to an insurance companycompany

DeductibleDeductible: the amount of money an : the amount of money an insured person must pay for services insured person must pay for services before an insurance company will pay before an insurance company will pay for the cost of services providedfor the cost of services provided

InsuranceInsurance

Group insurance: Employers offer Group insurance: Employers offer coverage to employeecoverage to employee

People not covered under a group People not covered under a group policy can purchase individual policy can purchase individual policies. These policies usually cost policies. These policies usually cost more than group insurancemore than group insurance

Insurance company decides what Insurance company decides what medical services will be covered.medical services will be covered.

Medicare and MedicaidMedicare and Medicaid

Programs are result of federal Programs are result of federal legislation.legislation.

Programs target people who lack Programs target people who lack access to care.access to care.

Medicare began paying hospitals Medicare began paying hospitals a flat fee for diagnostic related a flat fee for diagnostic related groups (DRGs)groups (DRGs)

MedicareMedicare

Largest health insurance Largest health insurance program in the nation.program in the nation.

Must be at least 65 years old Must be at least 65 years old or disabled to qualify.or disabled to qualify.

Part A provides for hospital Part A provides for hospital care, limited skilled nursing care, limited skilled nursing facility services, home health facility services, home health services, and hospice care.services, and hospice care.

MedicaidMedicaid

Government Government insurance for insurance for certain low-certain low-income people.income people.

Dental Dental coverage may coverage may be available.be available.

No co-payment No co-payment or deductible.or deductible.

INDIANA MEDICAID AND OTHER MEDICAL ASSISTANCE PROGRAMS

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Managed CareManaged Care

Health care plans specifically Health care plans specifically designed to control costs.designed to control costs.

AdvantagesAdvantagesMost include preventive care, such as Most include preventive care, such as

annual physicals, mammograms, and annual physicals, mammograms, and well-baby care.well-baby care.

Monthly premiums and out-of-pocket Monthly premiums and out-of-pocket expenses are usually lower than with expenses are usually lower than with traditional insurance.traditional insurance.

Reduced paperwork.Reduced paperwork.

Managed CareManaged Care

DisadvantagesDisadvantagesLimited choice of doctors and Limited choice of doctors and

hospitals, except for emergency hospitals, except for emergency treatment.treatment.

Must be referred to specialist by Must be referred to specialist by primary care physician.primary care physician.

Usually more restrictive than ordinary Usually more restrictive than ordinary insurance.insurance.

Not all health expenses count toward Not all health expenses count toward deductible.deductible.

Health Maintenance Health Maintenance OrganizationsOrganizations

Focus on prevention and Focus on prevention and wellness.wellness.

Businesses or individuals pay Businesses or individuals pay premiums to the HMO instead of premiums to the HMO instead of an insurance company.an insurance company.

HMOs focus on wellness care not HMOs focus on wellness care not usually covered by insurance.usually covered by insurance.

Popular in the 1980s and 1990s.Popular in the 1980s and 1990s.

Workers’ CompensationWorkers’ Compensation

Insurance that covers Insurance that covers accidents, injuries, or diseases accidents, injuries, or diseases that occur in the workplace.that occur in the workplace.

Federal law requires Federal law requires businesses to purchase and businesses to purchase and maintain a minimum amount maintain a minimum amount of workers’ compensation of workers’ compensation insurance.insurance.

Military Health CareMilitary Health Care

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