Health Care in the United States

Medicare Part B, Supplementary Medical Insurance (SMI)

-Asissits in paying for the cost of physician services, outpatient hospital services, medical equipment and supploes and some of the other health services and supplies -Finances through: (1) premium payment, which is usually deducted from the monthly Social Sevurity benefit checks, and (2) through contributions from general revenue of the U.S treasury

Medicare Part C, Medicare Advantage Program

-Coordinated care plans, which include health maintenance organizations (HMO), provider-sponsered organizations (PSO) and preferred provider organizations (PPO) -Other certified public or private coordinated care plans and entities that meet the approved required standards

Medicaid regulations and policies, each state

-Establishes it's own eligibility standards -Determines the type, amount, duration and scope of services -Sets the rate of payment for services -Administeres it's own program

Medicare Part A

-Hospital Insurance -Provides coverage with no premium costs, for inpatient hospitalt services, skilled nursing facilities, home health services and hospice care to all persons eligible

Coverage Under Medicaid Restrictions:

-Limits must result in a sufficient level of services to reasonably acheive the purpose of the benefits -Limits on benefits may not discrminate among beneficiaries based on medical diagnosis or condition

These liabilties may be paid by..

-The Medicare Beneficiary -A third party such as a Private Medigap insurance purchased by the Medicare Beneficiary -Medicaid, if the person is eligible

POS plan

-members can obtain care through an HMO provider network for the lowest out-of-pocket costs. -if members wish to access the larger PPO network, they are required to pay higher out-of-pocket costs

With some exceptions, a state's Medicaid plan must allow recipient's to..?

Hace some informed choices among participation providers of health care, and to recieve quality care that is appropriate and timely

Mangaged Care Plans

The Medical beneficiary selects a specific HMO or other approval plan within a service area for comprehensive healthcare services

Beneficiary Payment Liabilites

beneficiaries are responsible for charges not covered by the Medicare program and for various cost-sharing aspects of both HI and SMI

Medicaid

is a jointly funded, Federal-Stae health insurance program for low-income and people in need. It coveres children, the aged, blind and/or disabled and other people who are eligible to receive federally assisted income maintenance

HMO (Health Maintenance Organization)

is the most common MCO. There are various types such as staff, group practice, network independent practice association (IPA) and direct contact models.

Medigap

is used to mean private health insurance that, within limits, pays most of the healthcare service charges not covered by parts A and B of Medicare

Medicare

the federal health insurance program for people who are 65 or over. Certain younger people whit disabilities and people with End-Stage Renal Disease may qualify