Private and Public Insurance in the United States

4 Types of Managed-Care Insurance

1. Health Maintenance Organizations (HMOs) 2. Preferred Provider Organizations (PPOs) 3. Point of Service Plans (POSs) 4. Exclusive Provider Organizations (EPOs)

Exclusive Provider Organizations (EPOs)

Limited coverage, in-network only. Not out-of-network benefits.

Medicare Part B

Medical insurance - outpatient care

3 Types of Public

Medicare Medicaid CHIP

Medicare Part C

Medicare Advantage Plan (added on managed care)

Preferred Provider Organizations (PPOs)

Mix between fee-for-service and HMO. You can choose your physician, but you will pay more if they are out-of-network.

Indemnity or Traditional fee-for-service insurance: Preventive or Not Preventative

Not Preventative

Managed-Care Insurance insurance: preventative or not preventative

Preventative

Children Health Insurance Program

for uninsured children in families with income about poverty level, but too low to afford private health insurance

Point of Service Plans (POSs)

Can receive care from both in-network and out-of-network providers. Require a referral to visit out of network.

Medicaid

Federally aided, state-administered entitlement program that provides medical benefits for low-income, local welfare, inpatient and outpatient services, must be below 133% of poverty line

Health Maintenance Organizations (HMOs)

Finances and delivers health. Must use plan's providers, only exception is emergency services.

Medicare Part D

Prescription drug coverage

Two general categories of health insurance in the United States:

Private Government/Public Health Insurance

Indemnity or Traditional fee-for-service insurance

Provider charges a fee for every service rendered

Consumer-Directed Health Plans (CDHP)

Health deductible health plan with a tax-advantaged health reimbursement arrangement (HRA) or health savings account (HSA) of their health expenses.

Medicare Part A

Hospital insurance - inpatient care

Three types of Private Insurance:

Indemnity or Traditional Fee-or-Service Insurance Managed-Care Insurance Consumer-directed Health Plans

Medicare is a ____ run program for those _____ years or age.

Medicare is a federally run program for those >65 years of age.