Health Insurance is also called as payers or carriers in the United States of America.
- The term health insurance is generally used to describe form of insurance that pays for Medical expenses.
- Health insurance covers both inpatient and outpatient services.
- The person covered by Health insurance is called “INSURED/ENROLEE” and the spouse and children of the insured are called as “Covered/Dependents”
- A person can have more than one insurance for the service rendered by a Physician
Primary Health Insurance: The insurance which makes the payment first
Secondary Health Insurance: Whatever Primary health insurance denies that will be covered by Secondary health Insurance.
Supplementary Health Insurance: Supplementary health Insurance will cover the Co-Insurance and Deductible of Primary Insurance.
Medigap: A supplemental insurance for Patients with Medicare as their primary and these plans will cover the Medicare Deductible and Co-Insurance.
Types of Health Insurances
- Federal Health Insurance – Medicare, Medicaid, CHAMPUS – Tricare and CHAMPVA
- Commercial Health Insurance – BCBS, Aetna, Cigna and so on
In this article let us learn about Federal Health insurance in the United States of America:
Medicare Health Insurance
- Its a Federal health insurance which is administered by CMS – Centre for Medicaid and Medicare services
- Medicare insurance is the largest insurance program of United States.
Medicare health insurance Eligibility Factors
- A person should be more than 65 years and over
- ESRD – End Stage Renal Disease
- Medicare through Spouse
Medicare health insurance Plans
In Medicare health insurance we have two Plans
- Medicare Part A and
- Medicare Part B
Medicare Part A covers Hospital charges
Medicare Part B covers Medical charges
Difference between Medicare Part A and Part B
Medicare Part A
- Part A received automatically
- Need not purchase
- Covers inpatient hospital expenses
- Pays for Hospital, Skilled Nursing Facility and Hospice
Medicare Part B
- Need to Purchase
- Covers outpatient
- To purchase part B one should have part A
- Pays for consultation, outpatient Hospital services and for Durable medical equipment
Medicaid Health Insurance
- It is a Federal health Insurance
- Each state operates its own Medicaid programs with certain federal guidelines.
- Covers individuals and families with low income ad resource.
- There is no Patient responsibility in most cases.
- In some cases “SPEND DOWN CHARGES AND COPAY” is applied.
- It is also called as “LAST PAYER”.
Tricare Health Insurance, CHAMPUS and CHAMPVA
Tricare Health Insurance Plans
- Tricare Prime: For Active Military personnel
- Tricare Standard : For Retired Military personnel
- Tricare Extra : For Retired Military personnel
- Tricare for Life: Retired Military Personnel and their spouse (above 65 years) and covered when they have Medicare Part A and Medicare Part B.
- The Civilian Health and Medical Program for the Uniformed Services
- It is provided to military personnel and their dependents.
- Eligible beneficiaries must be listed in the defense department worldwide computerized database the Defense Enrollment Eligibility Reporting System (DEERS – Defence Enrollment Eligibility and Reporting System).
- The Civilian Health and Medical Program of the Veteran Affairs
- CHAMPVA is a comprehensive healthcare program in which the veterans Administration shares the cost of covered healthcare services and supplies with eligible beneficiaries.
- Covers spouse or child of a Veteran (who is permanently disabled or died from a service-connected disability.