HRPR 1001 Lecture Notes - Lecture 24: Managed Care, Health Care Reform, Medicare Part D

• School: Temple University
• Department: Health Related Professions
• Course: HRPR 1001
• Professor: Dr.Hatala

Document Summary

Money paid by insured person for the insurance policy on a monthly or yearly basis. Copayment money amount insured person is required to pay at time of service. Coinsurance- percentage of the charges that insured is responsible for paying. Out-of-pocket cost- cost of healthcare not covered by insurance (could be caps, deductibles, co- pays or just not a covered service). Cap- limit on money insurance will pay for service per year, benefit month or lifetime. Covered service- service for which insurance company will provide payment if individual is eligible. Deductible- money must be paid by the individual or family before the insurance coverage will kick in(ex. Pay first and then insurance picks up the rest). Started in 1965 as part of ss amendments. Each state administers its own medicaid programs based on broad federal guidelines and regulations. Prescribes the amount, duration, and types of services. Chooses the rate of reimbursement for services.