insurances

Question 1

fee for service

Answer 1

copay/ deductible

insurance reimburses pt. for all or portion of fee

pt. can go anywhere and pay for service

Question 2

HMO

Answer 2

copay

pt must go to specific provider (kaiser)

insurance pays pre-determined fixed fee for service

pt. must get a referral

Question 3

PPO

Answer 3

any providers BUT has financial incentives for specific ones

insurance pays pre-determined fixed fee for service; pt. pays balance of fee

no referral necessary

Question 4

POS

Answer 4

hybrid of HMO and PPO

primary provider serves as gatekeeper to coordinate pt. care

pt. can go outside the network

Question 5

government sponsored plans

Answer 5

medicare- people over the age of 65

medicaid- low income

tricare- armed forces