INTRODUCTION OF GOVT. INSURANCES 2024

INTRODUCTION OF GOVT. INSURANCES

A-Federal Insurance

1. Medicare http://Medicare.gov
2. Medicaid http://Medicaid.gov
3. Tricare
4. RR Medicare (RR-Rail Road)

Managed Care Plans:

To provide high-quality service at low Cost.

1. HMO (Health Maintenance Organization)

The patient must go to in-network Provider. PCP Must. (Low premiums, low deductible, copay &

coins). PCP means Primary care Physician.

Patient visits PCP first and PCP Issue Referral for specialist visit according to Diagnose.

2. PPO (Preferred Provider Organization)

The patient may go to any Healthcare Provider in the listed Panel doctors, anywhere; Including out of

Network If benefits are available.

3. EPO (Exclusive Provider Organization)

Similar to an HMO, with an EPO you must use network providers – doctors, hospitals, and other

health care providers – that participate in the plan. The only exception is for emergency care.

Unlike an HMO, you do not need to select a Primary Care Physician or contact

your PCP for referrals to specialists.

4. POS (Point of Services)

It’s companies with HMO+PPO

The patient goes to any network provider (In or Out). PCP Must.

POS plans combine elements of both HMO and PPO plans. Like an HMO plan, you may be

required to designate a primary care physician who will then make referrals to network

specialists when needed. Depending upon the plan, services rendered by your PCP are typically

not subject to a deductible, and preventive care benefits are usually included. Like a PPO plan,

you may receive care from non-network providers but with greater out-of-pocket costs. You may

also be responsible for co-payments, coinsurance, and an annual deductible.

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High Deductible Health Plan (HDHP): HDHPs have high deductibles and are often paired with Health Savings Accounts (HSAs) for tax benefits.

"INTRODUCTION OF GOVT. INSURANCES"

A High Deductible Health Plan (HDHP) is a type of health insurance that features higher deductibles and lower premiums compared to traditional health plans. Here’s a breakdown of its key characteristics and benefits:

"INTRODUCTION OF GOVT. INSURANCES"

Key Characteristics:

1. High Deductible:
2. Lower Premiums:
3. Health Savings Account (HSA) Eligibility:
4. Out-of-Pocket Maximum:
5. Preventive Services Coverage:

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Catastrophic Health Insurance: These plans are designed for young, healthy individuals and only cover major medical expenses.

Medicare and Medicaid: Government-funded programs that provide health insurance for specific

groups, such as the elderly (Medicare) and low-income individuals (Medicaid).

Short-Term Health Insurance: Temporary plans that provide coverage for a limited duration, typically up to 12 months.

Employer-Sponsored Health Insurance: Coverage employers offer to their employees, often with various plan options.

Indemnity or Fee-for-Service Plans: Traditional insurance plans that allow you to choose any healthcare provider but may have higher out-of-pocket costs.

Traditional Indemnity: Patients are billed and repaid for all or part of each service performed,

subject to deductibles and limits on coverage.

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COBRA:

The term COBRA is an acronym for the Consolidated Omnibus Budget Reconciliation Act of

1986—federal legislation that governs the operation of group-sponsored health plans of

businesses with twenty or more employees. The COBRA Plan will offer you and your dependents continuing healthcare coverage if you leave your job.

However, you will have to pay the entire COBRA premium on your own.

It’s possible to extend COBRA’s Coverage for up to 18 months and a surviving dependent can

receive further extensions

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HSA:

Health savings accounts (HSAs) are like personal savings accounts, but their money is

used to pay for health care expenses. You — not your employer or insurance company — own

and control the money in your health savings account. The money you deposit into the account is

not taxed. To be eligible to open an HSA, you must have a special type of health insurance called

a high-deductible plan.

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