Government-Funded Health Insurance Programs
Medicare
A federal health program for individuals aged 65 years and older, certain disabled individuals younger than 65, and those with permanent kidney failure or ALS.
Children's Health Insurance Program (CHIP)
A government-funded health insurance program specifically for children from families who earn too much money to qualify for Medicaid but cannot afford private insurance.
Medicaid
A joint federal and state health insurance program for low-income individuals and families.
Capitation
A payment arrangement where a healthcare provider is paid a fixed amount for each enrolled person assigned, regardless of whether that person seeks care.
Fee for service
A payment model where healthcare providers are financially rewarded for the volume of services provided rather than quality and cost control.
Prospective payment
A payment system in which hospitals are paid a predetermined amount for each patient in any established disease category and Diagnosis-Related Groups (DRGs).
Managed Care
A system that integrates the financing and delivery of appropriate health care using a comprehensive set of services.
Health Insurance Coverage
About 85% of those offered health insurance through their employer do not enroll due to cost or eligibility issues.
Healthcare Cost Control
Both public and private health insurance programs have moved to capitation in an effort to control rising healthcare costs.
Marketplace subsidies
Financial assistance provided by the government to help eligible individuals and families afford health coverage purchased through the Health Insurance Marketplace.
Medicare Expenditures in 2014
In 2014, Medicare benefit payments totaled $597 billion, with 25% covering hospital inpatient services and 25% covering private insurance through Medicare Advantage.
Medicaid Coverage
In 2019, Medicaid provided coverage to 1 in 5 Americans, making it the nation's largest public health insurance program.
Medicaid Expenditures in 2019
In 2019, expenditures for Medicaid, Medicare, CHIP, and Marketplace subsidies represented 25% of the total federal budget.
Private Health Insurance Enrollment
Only 61% of those offered health insurance through their employer actually enroll due to cost or eligibility issues.
Centers for Medicare and Medicaid Services (CMS)
The agency responsible for administering Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).
Health Maintenance Organizations (HMOs)
The first managed care insurance programs that were started in California and Washington State.
Blue Cross and Blue Shield
The organization that pioneered the first prepayment plan to cover physician services in 1939.