Health Care

Health Insurance in the United States of America

admin

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
  • Disabled
  • 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.

CHAMPUS

  • 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).

CHAMPVA

  • 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.