Medical Billing Part 3

Medicare

A federally funded insurance program for people 65 and older, people under 65 with certain disabilities, and people with end-stage renal disease

Medicaid

A federally mandated program that provides medical services to those who can’t afford them

What are the types of military medical insurance?

CHAMPUS/Tricare and CHAMPVA

CHAMPUS

Civilian health and medical program of uniformed services - established in 1966

Tricare

Department of defense healthcare program

Tricare for life

Program for Medicare eligible military retirees

CHAMPVA

For veteran families with permanent service connected disabilities

Workers’ compensation

Coverage to employees and dependents if they suffer a work related accident

Accident (Workers comp)

An unplanned or unexpected situation causing injury or death not due to any fault of the employee

Federal workers comp

Covers miners, maritime workers, and civilian government employees

State workers comp

Covers employers and employees in each state

Parts of Medicare

A, B, C (advantage plan), and D

Medicare plan A

Pays for medically necessary inpatient care. It is financed by social security payroll withholding tax and patients don’t have to pay a premium

Medicare plan B

Helps pay for services/supplies not covered by Medicare part A, like medical expenses, lab services, home health care, outpatient treatment, and blood. It is financed by monthly premiums.

Medicare plan C

‘Advantage plan’ pays a fixed amount for care every month to companies offering Medicare plans. It is offered by Medicare-approved private companies

Medicare plan D

Prescription drug coverage (doesn’t cover all costs, but assists with yearly out-of-pocket expenses). It is paid by monthly premiums, yearly deductibles, and copayments