PreMed unit 4
out-of-pocket
a medical bill that must be paid by the patient
how much of a person's health expenses does it pay?
after an individual pays a deductable, Medicare will cover 80% of all medical expenses
co-payment
an amount paid by the patient for a certain service
what is Medicare? who qualifies?
an entitlement program for any citizen age 65 or older, administered by the federal government
how does a Point of Service (POS) plan work? advantages and disadvanges?
clients must pay a premium and choose a primary physician from in-network deductable and co-payments are low, specialists may be non-network physicians, but coverage may be limited
how does a Health Maintenance Organization (HMO) work? advantages and disadvantages?
clients must pay a premium, deductable, and . co-payments disadvantage-clients must visit in-network doctors and select a primary care physician advantages-HMOs urge clients to practice healthy living and to recieve preventive treatments, cost of checkup is covered
how does a Prefeered Provider Organization work? what are the benefits?
clients must pay a premium, deductable, and co-payments clients do not have to choose a primary care physician, clients may visit non-network physicians, but covrage is greater with in-netwrok physicians, PPOs often have other fees and co-payments
what are the 3 basic types of managed care providers?
health maintenance organizations, preferred provider organizations, point of service
what services are typically included with medicad?
hospital services, preventative care, child vaccines, pediatric services, physician services, diagnostic test, x-rays, rehabilitation, and physical therapy
what are the 2 major differences between managed care adn indemnity insurance?
indemnity-payment for medical services, can go anywhere managed-choosing a helath care provider, choose specific doctor
what is the difference between individual and group insurance?
individual-when a peron purchases a policy and agrees to pay the entire premium for health coverage group-generally purchased through an employer, the premium is split between the employer and the person being insured
who typically qualifies for Medicad?
individuals and families who are deteremined by the state to be needy, each state determines its own definition of needy
what is the goal of managed care?
manage care plans that offer medical supplies through a system of health care providers
what are 2 medical assistance programs?
medicaid and madicare
what is medicad?
need-based program, designed by federal government, but administered by state . governments
what services are provided by part A and part B Medicare?
part A: hospital care part B: outpatient services
what is indemnity insurance?
patients must pay for all health care expenses out of their own pocket, afterward the insurance agency will reimburse the patient for a percentage of the expenses
co-insurance
the amount generally expressed as a fixed percentage an insured must pay against a claim after the deductable is satisfied
premium
the amount paid to an insurance agency for a health insurance policy
deductable
the amount that must be paid by the patient before the insurance agency will begin to make payments
what is socio-economics and what does it show?
the study of how economics is affected by society, culture, and politics, the need for medical assistance for eldery, disabled, and poor
what concepts is managed care built on?
to promote good health and to practice preventative medicine
what percentage of the US' gross national product is made from health care expenses?
15%
