Unit 2- WK5- Financing Health Care Flashcards
Who pays for or finances health care services ?
patients who pay for health care policies, employers, or government
Health insurance companies do not finance health care. What do they do ?
- They offer policies that assume risk for healthcare cost.
- They also process insurance claims.
In the third party payer system there are 3 players. Who makes up these parties ?
- Individual
- Healthcare provider
- Public and Private insurance
Who pays for health insurance policies ?
individual, employer, government
Health insurance benefits are based on:
types of services provided
amount of services provided
in network providers
out of network providers
cost sharing: deductibles, coinsurance, co-payments, out of pocket maximum
Define premium
amount paid/ month to insurance
Define deductible
amount you pay for covered health services before insurance starts to pay for healthcare
starts new each year
higher deductible to meet gives you a lower premium
Define coinsurance
% of cost of a covered health care service after you pay deductible.
Define copay
pre-determined rate paid for services
Define Out of pocket max
most you will have to pay in one year out of pocket for you health care.
Describe how deductibles, coinsurance and copayment work together.
A patient pays the full price of their visits until they meet their deductible, then for each visit after the deductible is met they will pay their coinsurance and their copayment
What is CMS and what entitlement programs does it offer ?
- Government supported health insurance.
- medicare, medicaid, CHIP
What health care services are covered under Medicare Part A ?
- Hospital Insurance, mandatory inpatient hospital care, SNF, LTACH, hospice, certain home health
- financed by federal taxes and federal revenue, FICA
What health care services are covered under Medicare Part B
Supplementary medical insurance, voluntary ( purchased)
physician services, outpatient, select home health, medical equipment, supplies
includes PT funded by premium payments
What health care services are covered under Medicare Part D ?
Prescription drug coverage
