Financing Health Care - Week 5 Flashcards
What did congress pass in December of 2020?
3.6% medicare payment cut
What is health Insuracne?
Policies purchased to pay for certain health-related services and goods such as medical surgical, and hospital expenses
Benefits: covered services reimbursed by the insurance policy
Who pays for Health Insurance Policies?
- Individual: purchase health insurance policy directly; out of pocket expenses
- Employer: offers health insurance coverage as a benefit to employees
• Government: federal government finances Medicare; federal and state governments finance Medicaid and the Children’s Health Insurance Program; US Department of Defense Military Health System
“entilitelment programs”
Does health insurance companies finance health care?
What do they do?
No ,
• Offer policies that assume
risk for health care costs
They,
• Process health insurance claims
• The administrative tasks add cost to health care
In the third-party payer system there are 3 players.
Who make up the first, second, and third parties?
- First party = individual seeking health care
- Second party = provider of health care
- Third party = public and private health insurers
Who finances Medicare?
federal government
Who finances Medicaid & Children’s Health Insurance Program?
federal and state government
Who pays for, or finances, health care services?
-
Health Insurance Benefit Plans are based on:
- types of services covered
- amount of services covered
- in network providers
- out of network providers
- Cost sharing: deductibles, coinsurance, co-payments, out of pocket maximum
Premium
- amount you pay for health insurance each month
- price varies on health plan or level of benefits purchased
Deductible
- amount you pay for covered health care services before your insurance plan starts to pay for services
- starts over each year
- choose plan w/ high deductible will lower the cost of monthly premium
Coinsurance
- Percentage of cost of a covered health services you pay after you pay your deductible
Co-payment
- predetermined flat rate you pay for health care services at the time of care after you met your deductible
Out of pocket maximum
- most you could have to pay in 1 year out of pocket for your health care, after you pay this then your health care pays 100% of the cost of covered services
In-Network Vs. Out-of-Network
- In-network providers contract with the insurance company to accept a specific fee for each service they bill
- Out of network providers can bill whatever they want for each service
