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INSURANCE & COSTS
HEALTH CARESERVICES
MEDICAL CARE(INSURANCE)
HEALTH MAINTANCE ORGANIZATION (HMO)– A TYPE OF GROUP HEALTH INSURANCE PLAN– MEDICAL NEEDS MET THROUGH A SET OF
DESIGNATED DOCTORS – ‘PRIMARY CARE PHYSICIAN’– MONTHLY PREMIUM / FEW OR NO OUT-OF-
POCKET EXPENSES
MEDICAL CARE(INSURANCE)
PREFERRED PROVIDER ORGANIZATION (PPO)– A TYPE OF HEALTH INSURANCE PLAN– DESIGNED BY INSURANCE COMPANIES– MEDICAL NEEDS MET THROUGH ANY DOCTOR AVAILABLE– CHARGE PEOPLE LESS THAN USUAL FEES FOR DOCTORS
WITHIN THE PROGRAM– CAN CHOOSE DOCTOR OUTSIDE OF PLAN – COSTS MORE– MONTHLY PREMIUM / CAN CHOOSE DOCTOR IN PLAN OR
ONE OUTSIDE OF PLAN
MEDICAL CARE(TERMS)
PRIMARY CARE PHYSICIAN– MEDICAL DOCTOR WHO PROVIDES PHYSICAL
AND CHECKUPS / GENERAL CARE
SPECIALISTS– MEDICAL DOCTORS TRAINED TO HANDLE
PARTICULAR KINDS OF PATIENTS OR MEDICAL CONDITIONS
MEDICAL CARE(INSURANCE)
MEDICAID– PUBLIC HEALTH INSURANCE THAT PAYS FOR
HEALTH CARE FOR PEOPLE ON WELFARE– PREMIUMS PAID FOR BY THE GOVERNMENT
ONLY– 30 BILLION PER YEAR
MEDICAL CARE(INSURANCE)
MEDICARE– PUBLIC HEALTH INSURANCE FOR PEOPLE 65 OR
OLDER AND THOSE WHO RECEIVE SOCIAL SECURITY
– VOLUNTARY ENROLLMENT– PREMIUMS SHARED EQUALLY BY PEOPLE AND
GOVERNMENT– 45 BILLION PER YEAR
MEDICAL CARE(INSURANCE)
MAJOR MEDICAL– DESIGNED TO GIVE LARGE AMOUNTS FOR MAJOR
EXPENSES– NOT SMALL OUT OF POCKET EXPENSES
COMPREHENSIVE– BASIC MEDICAL CARE PLUS MAJOR MEDICAL
COVERAGE INCOME (DISABILITY)
– BENEFITS WHEN ACCIDENTS OR SERIOUS ILLNESS OCCURS
MEDICAL CARE(SERVICES)
COSTS– ON AVERAGE OVER 125% MORE THAN 10 YEARS
AGO– REASONS:
CONSTRUCTION COSTS HOSPITAL EMPLOYEE SALARIES EQUIPMENT BECOMES OBSOLETE & UNUSUABLE MALPRACTICE INSURANCE
MEDICAL CARE(SERVICES)
FACILITIES– PRIVATE PRACTICES– CLINICS– GROUP PRACTICES– HOSPITALS– EMERGENCY ROOMS– URGENT CARE CENTERS
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