Healthcare Payment Methods

Healthcare Payment Methods

What do you know about how American's pay for their healthcare?

Health Insurance Terms

• Premium – the amount paid to an insurance agency for a health insurance policy 

• Deductible - the amount that must be paid by the patient before the health insurance benefits kick in and co-insurance starts

• Co-payment - The flat fee that an individual is expected to pay for a medical service, i.e. Doctor's visit

• Co-insurance - The percentage of money that you are expected to pay after the deductible is reached. Usually written as 80/20 or 90/10 for example

• Out-of-Pocket Max - After you have paid this amount of money, your health insurance will cover 100% of your costs for medical services

Multiple Choice

Which health insurance term is defined by: The flat fee that an individual is expected to pay for medical services, such as a doctors visit.

• Deductible

• Out-of-Pocket Max

• Co-payment

• Co-insurance

• Premium

Multiple Choice

Which health insurance term is defined by: The amount of money that you and/or your employer pays the insurance company as part of the insurance plan?

• Deductible

• Out-of-Pocket Max

• Co-payment

• Co-insurance

• Premium

Multiple Choice

Which health insurance term is defined by: The amount of money that an individual pays before the benefits of health insurance kick in and co-insurance starts?

• Deductible

• Out-of-Pocket Max

• Co-payment

• Co-insurance

• Premium

Multiple Choice

Which health insurance term is defined by: After you have paid this amount of money, your health insurance will cover 100% of your costs for medical services?

• Deductible

• Out-of-Pocket Max

• Co-payment

• Co-insurance

• Premium

Multiple Choice

Which health insurance term is defined by: The percentage of money that you are expected to pay after the deductible is reached, ex: 80/20.

• Deductible

• Out-of-Pocket Max

• Co-payment

• Co-insurance

• Premium

Indemnity Insurance

• In indemnity insurance, patients must pay for all healthcare expenses out of their own pockets. Afterward, the insurance agency will reimburse the patient for a percentage of the expenses. 

• Indemnity insurance does not work for everyone. Many people cannot afford to pay for their medical expenses out-of-pocket.

• Patient can choose any medical provider

Managed Care

• Managed care plans offer medical services through a system of healthcare providers. The system of providers offers services at reduced rates. 

• Patient must choose a medical provider that is in-network.

• Insurance company pays the medical provider directly.

Open Ended

What are some of the main differences between Indemnity Insurance and Managed Care?

Health Maintenance Organization Plan

• Clients must pay a premium, deductible, and co-payments.

• Clients must visit in-network doctors and select a primary care physician.

• Have to visit your primary care and get a referral to see a specialist doctor.

• HMOs urge clients to practice healthy living and to receive preventive treatments.

Preferred Provider Organization

• Clients must pay a premium, deductible, and co-payments.

• Clients do not have to choose a primary care physician.

• Clients may visit non-network physicians, but coverage is greater with in-network physicians.

• PPOs often have other fees and co-payments.

Managed Care Comparisons

HMO and PPO plans have similarities and differences. It is important to know how these types of managed care compare with each other.

Public Health Insurance Programs

• With public health insurance programs, the federal government finances healthcare services received by eligible groups of the population. 

• Medicaid

• Medicare

• Military Health Systems

• TRICARE

• Veterans’ Health Administration

Medicaid

• Needs-based program

• Designed by the federal government, administered by state governments

• Provides medical assistance to individuals and families who the state determines to be “medically needy.” Examples include: Blind or disabled, low-income families, people who receive social security benefits, etc.

• In addition to deciding who qualifies for Medicaid, states must also define the type, amount, duration, and scope of the services. Services vary from state.

Medicare

• Entitlement program for any citizen age 65 or older

• Administered by the federal government

• After deductible, Medicare will cover 80% of all medical expenses 

• Medicare is divided into Part A and Part B. The following services are provided by these parts:

• Part A: Hospital Care

  •Hospitalization, Skilled nursing facilities, Home healthcare, Hospice care, Long-term care facilities.

• Part B: Outpatient Services

  •Medical expenses, including MD services, physical therapy, occupational therapy, medical equipment, & diagnostic testing. Preventive care

Healthcare for the Military

• The U.S. Department of Defense operates the Military Health System which provides medical services to active duty and retired military members of the armed forces and their families.

• TRICARE is the health insurance program of the Military Health System. This is used by active military members and their families.

• The Veterans Health Administration (VHA) is the largest integrated health services system in the United States serving all military veterans.

Multiple Choice

What insurance would you recommend for a person who states, "I am 63 years old and was recently diagnosed with end stage renal disease."

• PPO

• HMO

• Medicare

• Medicaid

Multiple Choice

What insurance would you recommend to a person who says, "I am 28 years old and don't really care which doctor I see. I just want the highest coverage possible."

• HMO

• PPO

• Medicare

• Medicaid

Multiple Choice

What insurance would you recommend to a person who says, "I am 39 years old and I like to have control over what doctors I see."

• HMO

• PPO

• Medicare

• Medicaid

Multiple Choice

What insurance would you recommend to a person who says, "I am 29 and pregnant with my first child. I recently lost my job and struggle financially."

• HMO

• PPO

• Medicare

• Medicaid