HC finance Flashcards
Describe the history of healthcare financing, insurance,
government healthcare funding in the US
Before insurance for any healthcare spending patients were expected to pay out of pocket for all medical attention
WWII - employer sponsored plans as a benefit dramatically expanded as a direct result of wage controls
1946- hill burton act - hospital construction
the entire health insurance system was built on the employer sponsored model
in 1965 medicare (for retired) and medicaid (for the poor) became a thing
Describe the role of the ACA and the American Rescue Plan in expanding healthcare coverage to the uninsured in the US
Goals of the ACA was to improve accessibility to coverage, decrease number of uninsured, improve efficiency of providing care, improve quality of life, and decrease the cost of care
Describe who is eligibility for Medicare
enrollment
Medicare - begins July 1st 1966
Health insurance for those 65 or older, no dental or eye benefits, no drug benefits for outpatients
Describe the coverage of the different parts of Medicare.
Part A
- Covers hospital costs
Part B
- premium costs deducted from SS
- Covers physician costs
- Medical supplies
- Drug admin in MD offices
- does not cover long term-care, dental care, cosmetic surgery, eye exams, routine foot care, hearing aids and exams, acupuncture
Part C (medicare advantage plans)
- Part A + B + D
- managed care
Part D
- Drug benefit
- Premium costs deducted from SS
- the largest change in insurance processing in retail pharmacy history
Explain the concept of Medicare advantage plans (Part C)
and its advantages and disadvantages
-Premiums or the costs of services (co-pays and deductibles) can be lower than they are in Original Medicare or Original Medicare with a Medigap policy.
They may offer extra benefits including vision and dental
Describe common services provided by Medicaid
LTC, hospital, physician, home health, prenatal care, family planning services
optional services - pharmacy, dental, ICF for mentally retarded, mental health rehab
Describe strategies to control costs and maximize
outcomes for Medicare, Medicaid, and employer-provided
insurance and health benefits
-Require the federal government to negotiate prices for some drugs covered under Medicare Part B and Part D with the highest total spending, beginning in 2026
-Require drug companies to pay rebates to Medicare if prices rise faster than inflation for drugs used by Medicare beneficiaries, beginning in 2023
-Cap out-of-pocket spending for Medicare Part D enrollees and make other Part D benefit design changes, beginning in 2024
Describe who is eligibility for Medicaid
enrollment
Begins January 1st 1966
- managed by state government
- impatient and outpatient
- health insurance for the poor and medically indigent of all ages
- low income families who meet certain state requirements less than 138% of FPL in IN
- children born to medicaid-eligible pregnant women
- Children less than 6 YO and preganant women with incomes less than 138% of FPL
