Health industry today

Medicare

A government-funded program that is funded by federal taxes, targeting individuals over the age of 65 and those with disabilities.

Who is the main target of Medicare?

Individuals over the age of 65 and people of any age with disabilities that prevent them from working.

Medicaid

An insurance program for people with low incomes and few personal assets, where eligibility is determined by states following federal guidelines.

How is Medicaid funded?

It is funded by state and federal taxes.

TRICARE

An insurance plan offered by the Military Health System to active duty personnel, retirees, and their families.

Worker's Compensation

A form of government insurance providing wage replacement and medical benefits for employees injured at work.

Can you sue your employer if you accept Worker's Compensation?

No, accepting Worker's Compensation means the injured employee gives up the right to sue the employer for negligence.

Affordable Care Act (ACA)

Legislation passed in 2010 aimed at increasing the quality and affordability of health insurance.

How long can dependents be covered under their parents' insurance policies according to ACA?

Dependents can be covered until age 26.

Managed care

A general term for healthcare plans that emphasize wellness and provide care through a network of providers.

What are the common forms of private medical insurance?

Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO).

Health Maintenance Organization (HMO)

A managed care organization that provides prepaid healthcare at a flat rate through a network of providers.

What do policyholders select during an HMO?

Policyholders select a primary care physician (PCP) and must obtain referrals from the PCP to see specialists.

Preferred Provider Organizations (PPO)

Health insurance organizations that contract with a network of preferred providers from which policyholders can choose.

What do PPOs include?

PPOs involve an annual deductible payment, do not require a designated PCP, and allow self-referrals to specialists.

Deductible

The amount paid out of pocket before insurance covers the cost.

High deductible equals…

Low premium/monthly bill.

Low deductible equals…

High premium/monthly bill.

United States Public Health Service (USPHS)

A federal agency aiming to promote public health; it works alongside state and local health departments.

Occupational Safety and Health Administration (OSHA)

An agency that imposes legislation to prevent injury, illness, and death in the workplace.

Centers for Disease Control and Prevention (CDC)

An organization that monitors and prevents disease outbreaks and responds to health threats.

Food and Drug Administration (FDA)

An agency that protects public health by regulating food, human and veterinary drugs, and medical devices.

National Institutes of Health (NIH)

An organization conducting and supporting medical research.

World Health Organization (WHO)

An agency that directs and coordinates health-related matters on a global scale, providing standards, leadership, and support.