Healthcare Flashcards
What are public payers?
A public payer is the federal or state government. There are several types of publicly funded insurance: Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Veteran’s Administration.
What are private payers?
Private health insurance refers to any health insurance coverage that is offered by a private entity instead of a state or federal government. Insurance brokers and companies both fall into this category.Jan
What is medicare?
A U.S. federal health insurance program for people aged 65 years or older and people with certain disabilities. Medicare pays for hospital stays, medical services, and some prescription drugs but people who receive Medicare must pay part of their healthcare costs.
What is medicaid?
Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services.
What is an insurance premium?
The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance.
What is a deductible?
The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a. copayment.
What is coinsurance?
Coinsurance is the percentage of covered medical expenses you pay after you’ve met your deductible. Your health insurance plan pays the rest. For example, if you have an “80/20” plan, it means your plan covers 80% and you pay 20%—up until you reach your maximum out-of-pocket limit.
What is coinsurance?
Coinsurance is the percentage of covered medical expenses you pay after you’ve met your deductible. Your health insurance plan pays the rest. For example, if you have an “80/20” plan, it means your plan covers 80% and you pay 20%—up until you reach your maximum out-of-pocket limit.
What is a copayment?
A copayment or copay is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed.
What is CHIP (Children’s Health Insurance Program)
CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage, and works closely with its state Medicaid program. (CHIP) insures children up to age 19 from families with incomes too high to qualify for Medicaid.
Do you have to pay out of pocket for medicaid / CHIP?
CHIP programs have more flexibility to charge premiums and cost sharing, but both Medicaid and CHIP limit total family out-of-pocket costs to no more than 5% of family income, and states are required to maintain tracking systems to cease cost-sharing once a family meets the cap.
What is the average national health insurance cost monthly?
As of 2020, it was $453 for one individual.
What is a third party payer?
The term “third-party payment” refers to anyone paying for medical treatment who isn’t the patient. This may be a public entity or a private one. The government use funds obtained from current workers’ taxes instead of insurance premiums to pay healthcare providers.
What are the traditional tenets of competition in healthcare?
Price, quality, convenience, superior products and services and also technology and innovation.
What is the role of healthcare administrators?
Administrators serve as the hub of the wheel that keeps the healthcare industry rolling. They make sure that doctors, insurance companies, patients, and other providers have access to the information needed to ensure proper care. Without them, treatments are delayed, payments lost, and quality of care suffers.
What is administrative waste in healthcare?
Administrative waste is the excess administrative overhead that stems primarily from the complexity of the U.S. insurance and provider payment systems, and operational waste refers to other aspects of inefficient production processes. Clinical waste is waste created by the production of low-value outputs.
Elucidate some of the components that contribute to the complexity of the US healthcare system
The U.S. healthcare system is extremely complex, with separate rules, funding, enrollment dates, and out-of-pocket costs for employer-based insurance, private insurance from healthcare.gov, Medicaid, and Medicare, in all its many pieces. In each of these sectors, consumers must choose among several tiers of coverage, high deductible plans, managed care plans (HMOs and PPOs), and fee-for-service systems. These plans may or may not include pharmaceutical drug insurance which has its own tiers of coverage, deductibles, and copays or coinsurance.
What is an insurance claim?
An insurance claim is a request for your insurance company to pay for something your insurance covers, such as a car accident, a house fire or a visit to the emergency room.
How come administrative costs are so extortionately expensive in the US healthcare system?
For providers, this means dealing with myriad regulations about usage, coding, and billing. And, in fact, these activities make up the largest share of administrative costs
