Wisconsin has been a leader in trying to provide low cost health insurance for those individuals who are unable to access or qualify for employer sponsored plans. This presentation was part of a kaizen event for clinic personnel on the prior authorization proccess.
The idea of Medicare was born when Harry S Truman called for a health insurance fund in 1945. Truman’s dream was realized when Lyndon B. Johnson signed it into law in 1965...Read more here
http://www.bluegoosemaine.com/deep-dive-into-medicare-insurance-trends-2020/
Read the latest benefits information from Independent Medicare broker Erin Hart from American HealthCare Group. Learn about Medicare income limits, care plans, and topics to consider when planning for health benefits in retirement.
The idea of Medicare was born when Harry S Truman called for a health insurance fund in 1945. Truman’s dream was realized when Lyndon B. Johnson signed it into law in 1965...Read more here
http://www.bluegoosemaine.com/deep-dive-into-medicare-insurance-trends-2020/
Read the latest benefits information from Independent Medicare broker Erin Hart from American HealthCare Group. Learn about Medicare income limits, care plans, and topics to consider when planning for health benefits in retirement.
Obamacare - The Patient Protection and Affordable Care Act - ACAAndrew F. Bennett
This short presentation will help bring you up to speed on the Affordable Healthcare act, eligibility requirements to buy in the online marketplace, and coverage that will be available.
The Patient Protection and Affordable Care Act (Obama Care) provides opportunities for individuals and very small businesses to obtain affordable health insurance. More people will be covered in states like California which are expanding Medicaid (Medi-Cal) coverage. It is a complicated law but we hope that this presentation can give a suitable overview for the way the law is being implemented in the State of California.
Beyond Medicare – Meeting the Needs of Senior CustomersGen Re
There is no time like the present for insurers to consider growing their senior product portfolio with either Medicare Advantage or Medicare Supplement insurance. However, it’s important to understand some clear differences between these products and which needs they address for customers.
Read more: http://www.genre.com/knowledge/blog/meeting-the-needs-of-senior-customers-en.html
A health insurance roadmap takes a look at some simple solutions to the complex issues facing health insurance, medicare, medicaid, long term care insurance, and the high cost of health expenses in retirement.
This will work because so much of this is already in place and a lot of the rest would be quick and easy to implement. As in all areas, knowledge is power. Consumers can take control of your insurance portfolio by becoming educated about insurance. Better education and understanding will lead to positive results for consumers and for the insurance industry.
http://www.symbiusmedical.com/ - This article can help you navigate the often misunderstood new world of healthcare - the Affordable Care Act. As of 2014 non-grandfathered individual and small group health plans must provide the essential health benefits (EHBs). EHBs will include items & services in 10 statutory benefit categories. Individuals are able to shop for insurance coverage on state health insurance exchanges, called “marketplaces.” The article is written by Symbius Medical Corporate Compliance Manager, Natalie Franklin.
Join us as we learn about the benefits of the Affordable Care Act, the ways you can get help paying for insurance, and where you can get help enrolling. (Hint: We can help!)
Medicare 101 Presentation from Erin Hart, American HealthCare GroupMary Hagan
Erin Hart is an independent licensed Medicare Broker who helps retirees and seniors decide which Medicare benefit is the best choice for them. She meets with individuals or employer and community groups.
THE BIDEN PLAN TO PROTECT & BUILD ON THE AFFORDABLE CARE ACTDr Matthew Boente MD
From the time right before the Affordable Care Act’s key coverage-related policies went into effect to the last full year of the Obama-Biden Administration, 2016, the number of Americans lacking health insurance fell from 44 million to 27 million – an almost 40% drop. But President Trump’s persistent efforts to sabotage Obamacare through executive action, after failing in his efforts to repeal it through Congress, have started to reverse this progress. Since 2016, the number of uninsured Americans has increased by roughly 1.4 million
Emeritrust Benefits provides a Medicare educational seminar to help explain what Medicare does and does not cover. We also explain what other types are available including Medicare supplement plans, Medicare Advantage Plans, and Medicare Part D drug plans.
Obamacare - The Patient Protection and Affordable Care Act - ACAAndrew F. Bennett
This short presentation will help bring you up to speed on the Affordable Healthcare act, eligibility requirements to buy in the online marketplace, and coverage that will be available.
The Patient Protection and Affordable Care Act (Obama Care) provides opportunities for individuals and very small businesses to obtain affordable health insurance. More people will be covered in states like California which are expanding Medicaid (Medi-Cal) coverage. It is a complicated law but we hope that this presentation can give a suitable overview for the way the law is being implemented in the State of California.
Beyond Medicare – Meeting the Needs of Senior CustomersGen Re
There is no time like the present for insurers to consider growing their senior product portfolio with either Medicare Advantage or Medicare Supplement insurance. However, it’s important to understand some clear differences between these products and which needs they address for customers.
Read more: http://www.genre.com/knowledge/blog/meeting-the-needs-of-senior-customers-en.html
A health insurance roadmap takes a look at some simple solutions to the complex issues facing health insurance, medicare, medicaid, long term care insurance, and the high cost of health expenses in retirement.
This will work because so much of this is already in place and a lot of the rest would be quick and easy to implement. As in all areas, knowledge is power. Consumers can take control of your insurance portfolio by becoming educated about insurance. Better education and understanding will lead to positive results for consumers and for the insurance industry.
http://www.symbiusmedical.com/ - This article can help you navigate the often misunderstood new world of healthcare - the Affordable Care Act. As of 2014 non-grandfathered individual and small group health plans must provide the essential health benefits (EHBs). EHBs will include items & services in 10 statutory benefit categories. Individuals are able to shop for insurance coverage on state health insurance exchanges, called “marketplaces.” The article is written by Symbius Medical Corporate Compliance Manager, Natalie Franklin.
Join us as we learn about the benefits of the Affordable Care Act, the ways you can get help paying for insurance, and where you can get help enrolling. (Hint: We can help!)
Medicare 101 Presentation from Erin Hart, American HealthCare GroupMary Hagan
Erin Hart is an independent licensed Medicare Broker who helps retirees and seniors decide which Medicare benefit is the best choice for them. She meets with individuals or employer and community groups.
THE BIDEN PLAN TO PROTECT & BUILD ON THE AFFORDABLE CARE ACTDr Matthew Boente MD
From the time right before the Affordable Care Act’s key coverage-related policies went into effect to the last full year of the Obama-Biden Administration, 2016, the number of Americans lacking health insurance fell from 44 million to 27 million – an almost 40% drop. But President Trump’s persistent efforts to sabotage Obamacare through executive action, after failing in his efforts to repeal it through Congress, have started to reverse this progress. Since 2016, the number of uninsured Americans has increased by roughly 1.4 million
Emeritrust Benefits provides a Medicare educational seminar to help explain what Medicare does and does not cover. We also explain what other types are available including Medicare supplement plans, Medicare Advantage Plans, and Medicare Part D drug plans.
Demystifying the Health Care Law Presentation Deck Handout Oct 11 2012Tricia Sandiego
Understanding the health care law shouldn’t feel like a Sherlock Holmes mystery. Although with so much information out there, it can sometimes be difficult to weed out the facts from the fiction. This presentation will help you debunk some of the myths and have a clearer understanding of the changes and improvements in the law and how each applies to you.
Learn what the health care law means for:
People with health insurance.
People who are uninsured or buy their own coverage.
Small business owners.
People with Medicare.
People planning for their long-term care.
Chapter 18 Private and Government Healthcare Systems PriMorganLudwig40
Chapter 18
Private and Government Healthcare Systems
Private and Government Healthcare Systems
In the United States, health insurance coverage is generally classified as either private (non-government) coverage or government-sponsored coverage.
Healthcare Coverage vs. Uninsured
The National Center for Health Statistics defines health insurance as public and private payers who cover medical expenditures incurred by a defined population in a variety of settings.
In the United States, the risk of becoming uninsured increases significantly for those earning low wages, the unemployed, and when employers are unable to provide insurance to workers.
Table 5-2 presents the trend of declining health insurance coverage.
Private Health Insurance
The concept of insurance is to combine the healthcare experiences of many enrollees in order to reduce expenses for any one individual to a manageable prepayment amount.
Employment-Based Plans is coverage offered through one’s own employment or a relative’s employment.
It may be offered by an employer or by a union.
Private Health Insurance Continued
Direct-Purchase/Fee-For-Service Plans are the traditional type of healthcare policy.
The physician sets a price for each type of service delivered, and then the client or insurance company pays the fee.
This type of health insurance provides the most choices of doctors and hospitals.
Private Health Insurance Continued
The two kinds of fee-for-service coverage are basic and major medical.
Basic covers some hospital services and supplies, such as X-rays and prescribed medicine.
Major medical insurance covers the cost of long-term, high-cost illnesses or injuries plus whatever basic did not cover.
Private Health Insurance Continued
Group Contract Insurance—to make hospitals and physicians products and services affordable to ordinary people in the United States.
With unmanaged care (fee-for-service) payments, healthcare providers could increase the number of single services they deliver in order to increase profit.
Private Health Insurance Continued
Managed Care—manages the cost and delivery of healthcare services, the quality of that healthcare, and access to care.
Managed care influences how much healthcare clients can use.
Health Maintenance Organizations (HMOs) are prepaid health plans.
The goal of an HMO is to provide affordable, well-organized healthcare by allowing clients to prepay (capitation payment) on a regular monthly basis for all services provided.
Private Health Insurance Continued
Including physicians’ visits, hospital stays emergency care, surgery, laboratory (lab) tests, X-rays, and therapy for all members and their families.
There may be a small co-payment for each office visit, such as $15 for a doctor’s visit or $50 for hospital emergency room treatment.
Private Health Insurance Continued
Point-of-Service Plans (POS) offer enrollees the option of receiving services from participating or nonparticipating prov ...
Although the Affordable Care Act has benefited the health insurance consumer in many respects, it has also added to the confusion. This presentation, Given by Wanda Stephens in Raleigh, North Carolina, details some of the many facets to Obamacare in NC.
for more information visit http://www.hisonc.com/obamacare-north-carolina/
The effects on insurance coverage for people living with HIV/AIDS in the Philadelphia EMA (including Philadelphia, Montgomery, Delaware, Chester, and Bucks Counties in PA and Salem, Gloucester, Camden, and Burlington Counties in NJ)
Similar to Understanding Wisconsins Health Plan Options (20)
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
1. Understanding Wisconsins Health Plan Options An explanation of the various programs, eligibility and the ramifications for the providers
2. HIRSP Health Insurance Risk Sharing Plan MAPP Medicaid Purchase Plan Forward Health BadgerCare BadgerCare Plus Badger Care Core Plus Medicaid Medicare Commercial Insurance Listing of Wisconsin Programs
3. Created in 1979 for people who are unable to find adequate health insurance in the private market due to pre-existing conditions or who have lost employer sponsored group insurance Individuals who have incomes above the federal poverty level HIRSPWhat is it? Who is eligible?
4. Wisconsin Medicaid Program Offers people with disabilities who are working or interested in working the opportunity to buy health care coverage through the Wisconsin Medicaid Program Depending on the individuals income, a premium payment may be required Medicaid Purchase Plan MAPPWhat is it? Who is eligible?
5. Forward Health is the name for multiple programs administered by the State of Wisconsin The programs include Health Care, like Badger Care and MAPP, Nutrition Programs like WIC, FoodShare Wisconsin, Other programs like energy assistance, Wisconsin Works (W2), SSI, etc. Go to the Forward Health website for a complete listing Forward HealthWhat is it?
6. Health care cost reimbursement program created by former Governor Tommy Thompson Went into effect July 1, 1999 and was created to provide health care coverage to Wisconsinites who’s employer didn’t provide it or who made too much money to be covered by Medicaid Program was altered in 2008 to BadgerCare+ so that all children would have access to healthcare who were not otherwise covered Badger CareWhat is it? Who is eligible?
7. Plan to make sure every child in Wisconsin has access to affordable health insurance Expands health insurance coverage and benefits for pregnant women Provides health insurance to parents and caretaker relatives Goal was to ensure that 98% of Wisconsin residents have access to quality, affordable health care BadgerCare+What is it?
8. All children under 19, regardless of income Pregnant women with incomes up to 300% of the federal poverty level (FPL) Parents and relatives caring for a child up to 200% of the FPL Young adults in foster care who turn 18 are automatically enrolled until they are 21 Farm families and other self employed families if income is under 200% of the FPL Must prove Wisconsin residency & citizenship Badger Care + Who is eligible?
9. Limited plan that covers basic health care services including primary and preventative care as well as generic drugs For people who are not getting BadgerCare +, Medicaid or Medicare For people who do not have access to employer sponsored insurance, or cannot sign up for employer insurance for three months and who did not have access to employer sponsored insurance for 12 months prior to requesting Core+ coverage Badger Care + Core PlanWhat is it?
10. Ages 19-64 Do not have children or dependant children under 19 living with them Not pregnant Family income at or below 200% of FPL Are Wisconsin residents and are U.S. citizen or legal immigrant Must apply and pay an application fee Have to pay monthly premiums based on income Badger Care Core+Who is eligible?
11. Joint federal and state program established in 1965 under Title XIX of the federal Social Security Act BadgerCare extends Medicaid coverage through a Medicaid expansion under Titles XIX and XXI Goal of BadgerCare is to extend gap between Medicaid and private insurance without replacing or crowding out private insurance MedicaidWhat is it?
12. Medicaid used to cover some of the same people as Badger Care plus Now Medicaid applies only to the elderly, blind and disabled BadgerCare + is Wisconsin’s program for families, pregnant women and minors seeking affordable health insurance MedicaidWho is eligible?
13. Medicaid policies and procedures that are published apply to both the Wisconsin Medicaid and Badger Care Plus Badger Care Plus has two plans within it, the standard plan and the benchmark plan Badger Care Benchmark plan may differ from Badger Care Plus and Medicaid in coverage, prior authorization, cost-sharing and reimbursement On line handbook must be used to research coverage, prior authorization and reimbursement for clarification Program administration
14. Communicated on line via the handbooks and updates Forward Health is the portal for information on all Badger Care and Medicaid HIRSP has separate guidelines for prior authorization and coverage conditions, the provider section of their website lists the procedures that require prior authorization WPS administers the HIRSP plan, at times you may be redirected to the WPS website Wisconsin Program changes
15. Wisconsin has been on the forefront of expanding healthcare coverage for all its residents Badger Care Plus was ahead of the national program SCHIP which is the federal program for health care coverage for children The future of these programs remains to be seen as healthcare reform evolves Badger Care may be the format that the state uses to comply with the federal changes Putting it all together
16. Funding for Medicaid & Badger Care products is 60/40. With the federal government providing 60% of the funding to the state and the state providing another 40% Provider rates are poor, usually less than Medicare FPL determinations used to vary state by state, however new health care reform bill standardizes it to 133% of FPL Putting it all together
17. HIRSP program in theory could dissolve with the new health care legislation which will require insurance companies to cover pre-existing conditions Look for some standardization of coverage with the new legislation, there may no longer be differences in what programs require prior authorization, and what is a covered service Under the new health care legislation Wisconsin’s state Medicaid cost would actually go down Putting it all together
18. 3 Plans Part A Automatic benefit with Social Security, provides inpatient hospital coverage, an annual deductible is paid by beneficiary Part B Medical insurance benefit that provides outpatient coverage, there is a monthly premium as well as an annual deductible to be paid by beneficiary Part D Prescription Drug Coverage there is a monthly premium as well as an annual deductible to be paid by beneficiary Medicare
19. Medicare Part B is paid for using a deduction from Social Security. For 2010 it is $96.40 per month, with a $155 annual deductible and a 20% coinsurance. There is a income adjustment for individuals with over $85,000 per year of income Medicare Part D is also paid for using a deduction, however the formula for premiums is specific to the individual and individuals need to go on line or call to enroll Medicare Supplements
20. Why purchase? Covers the 20% coinsurance for Medicare Part B, which can add up for patients that frequently use health care Covers the Part A inpatient deductible Can get coverage for prescription drugs depending on the plan Can get additional coverage for home health care, durable medical equipment, nursing home, etc. Medicare Supplemental Insurance
21. HMO Health Maintenance Organization PPO Preferred Provider Organization POS Point of Service Indemnity Medicare Advantage Insurance plans
22. Prepaid medical care HMO pays a particular contracted provider for care Usually operates on a closed panel basis which means individuals are required to seek care from a particular provider who is contracted with the HMO in order for the care to be paid Limit care to a specific geographic region HMO
23. Providers agree to provide care on a reduced fee to this organization or plan Insured persons are incentivized to use providers in the plan or network because they have less out of pocket cost to use the contracted providers Use of websites and provider handbooks by the insurance plan is common as people can search for an in network provider Less restrictive than an HMO PPO
24. Usually offered by HMOs as it allows individuals enrolled in the HMO some ability to choose providers that are not on the HMO panel Out of pocket costs are less for using a point of service contracted provider Benefits are that it is less restrictive than a pure HMO plan, but it is not as open as PPO plan Use of a non POS provider requires higher copayments and deductibles be paid POS
25. Fee for service plan Monthly premium paid by employer and employee or individual Contract between policyholder and insurance company Least restrictive option as individuals can go more freely to providers that take the insurance product purchased Indemnity
26. Federal program whereby individual can obtain Medicare coverage through private insurance Insurance companies handle all the claims for care and federal government pays the insurance company a defined amount for the insured person Insurance company’s incentive is to negotiate good prices with providers so that they are able to maintain a profit margin Medicare Advantage Plan
27. In 1995 50.1% of commercial insured Wisconsinites had HMO coverage. In 2009 it was down to 41.7% In 1995 8.4% of commercial insured Wisconsinites had POS coverage. In 2009 it was up to 38.6% In 1995 14.4% of commercial insured Wisconsinites had PPO coverage. In 2009 it was up to 18.2% In 1995 27.1 % of commercial insured Wisconsinites had indemnity coverage. In 2009 it was down to 1.4% Wisconsin Trends in Insurance
28. Not just in Wisconsin but through out the nation administrative headaches A January 2010 article “The High Cost of Dealing with Insurance” put the staffing cost per physician of dealing with insurance at $68,274 per year. Of that $21,796 was nursing and $25,040 was clerical (MGMA Connexion January, 2010) It is likely not to get better in the near future Trends in dealing with insurance and health care payers
29. Wisconsin has been a leader in expanding health insurance coverage to its citizens Wisconsin health care providers are experiencing the same administrative headaches related to insurance as the rest of the nation Wisconsin’s variety of state run programs makes things more challenging administratively to provide care to the individuals covered In summary