Macias Unit 8 Essays

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Des Moines Area Community College *

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120

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Health Science

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Feb 20, 2024

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docx

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1. Discuss the differences and similarities of the third-party healthcare insurance plans. Please make sure that you include in your essay the different managed-care plans. There are several diverse types of Third-party payer insurances. Some of the most common ones would be Medicare, Medicaid, insurances purchased through employers, then a variety of private insurances. Most third-party payer insurance are managed care plans. Which means that they have certain providers that the patients can see. They also have a set amount that they will pay the provider for the services. The difference between would be who the policies are provided through. Such as Medicaid and Medicare are provided by the state and federal government. Insurances provided from employers are just private insurances companies. Some require you to pay coinsurance, copays, and deductibles and government provided insurance normally do not. There are insurances companies that are HMOs which only pay for coverage to the providers that are in the network. Then there are PPOs which pay more to providers who are in network but will pay ones that are not in network. Then there is another managed care which is POS, it lets you decide between PPO and HMO every time you have a visit. One of the biggest similarities is that they are all the third-party payer. Medicare and Medicaid are known as public provided insurances, which makes the government the third-party payer. Managed and preferred provider care plans are third party payers for the private insurances' plans. 2. Discuss the differences between Medicare and Medicaid. Be sure to include information regarding federal and state laws governing the two different types of insurance, qualifications, and limitations of each program. Medicare is a federal program that is the largest health insurance provider in the U. S. Medicare only offers insurance to people who are 65 years or older, disabled, have end-stage renal disease, receive social security or railroad benefits, or employed by a job for ten years that paid into Medicare. Medicare also has four parts to it and not everyone covered get every part. There is a certain part of Medicare to pay for outpatient, inpatient, prescription, then the fourth one cover what the part A does not. These parts are Medicare Part A; inpatient, Medicare Part B; outpatient, Medicare Part C; the one that covers extra parts or your choice, then Medicare Part D; prescriptions. Medicaid is a federal and state program, which all aspects depend on what state policies are. Medicaid offers insurance to the low-income, have certain medical issues, and special groups. Each state has different requirements and each state offers diverse types of coverage. If a family qualifies for TANF, SSI, or are pregnant and children under 6 but are under the federal poverty level the federal government states they are required to be eligible for Medicaid.
References: DeMerceau, J. (2022). Define Third-Party Health Insurances .Chron. https://smallbusiness.chron.com/define-thirdparty-health-insurance-43641.html U. S. National Library of Medicine. (2021). Managed Care . Medline Plus. https://medlineplus.gov/managedcare.html Green, M. A. (2023). Understanding Health Insurance: A Guide to Billing and Reimbursement. https://purdueuniversityglobal.vitalsource.com/#/books/9781337418751/
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