Health care plans

Question 1

HMO - Health Maintenance organization

Answer 1

Restricted to a limited panel of in-network providers, except in emergencies.

Low premiums, copays, and deductibles and low overall cost.

Only covers things that meet established, evidence-based guidelines.

Requires a referral from primary care provider to see a specialist.

HMOs use Capitation - the client pays a fixed predetermined fee and then must receive all their care in network. Companies use HMOs for their low cost often.

Question 2

POS - Point of Service

Answer 2

A little more expensive than HMOs, with added benefit that patients can see providers outside of the network at an increased out of pocket costs - higher copays and deductibles.

Requires referral from primary care to see a specialists.

Question 3

PPO - Preferred Provider Organization

Answer 3

The most flexible and the highest cost.

Can see doctors in or outside of network.

All services have higher copays and deductibles.

Does NOT need referral to see a specialist.

Question 4

EPO - Exclusive Provider Organization

Answer 4

Patients are limited to in-network doctors, specialists, and hospitals, but do NOT require a referral to see a specialist.

Question 5

Capitation

Answer 5

Doctors get a set amount for each patient assigned to them for the designated period of time, regardless of how much the patient uses the healthcare system.

Question 6

Discounted fee for service

Answer 6

Patient pays for each individual service at a predetermined, discounted rate.

Question 7

Global payment

Answer 7

Patient pays for all expense associated with a single incident in a single payment.

Most commonly used for elective surgeries.

Question 8

Medicare

Answer 8

for patients over 65, disabled patients, and patients with end stage renal disease.

Part A: Hospital insurance, home hospice care.
Part B: Basic medical bills
Part C: Combo of parts A and B, delivered by private Companies
Part D: Prescription Drugs.

we carE for the Elderly

Question 9

Medicaid

Answer 9

Joint federal and state.
For people in poverty.

aiD for the Destitute.

Question 10

Hospice care

Answer 10

Available to those on Medicaid and Medicare and most private insurances once life expectancy is less than 6 months.

Patients can get opiates to palliate their pain even though it shortens their life, known as the Principle of Double effect.