Institute: ONC | Component: 1 | Unit: 4 | Lecture: d | Slide: 10
Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 1
Lecture:Payors in the U.S. Health Care System
Slide content:Public vs. Private Insurance Public Government run Medicare Medicaid Childrens Health Insurance Program (CHIP) Private Individual organizations State-licensed companies Self-insured employer plan ERISA regulates Third-party administrator 10
Slide notes:The two basic types of health insurance are public and private with the difference being who is responsible for the programs. Public insurance is run by the federal government, state government, or both, meaning the government provides the coverage and pays the providers. Medicare is for people age 65 and older and for people with certain disabilities. Medicaid is for low-income people. CHIP provides low-cost health insurance coverage to children in families that earn too much qualify for Medicaid but cannot afford private health insurance. Medicaid and CHIP receive federal funding, but are administered by the states. Private health insurance is funded and run by individual organizations that are licensed by a state. Consumers usually obtain private insurance through their employer. In some cases, employers self-insure, in which case they finance and pay for all the health care expenditures of their employees. These plans use the guidelines in the Employee Retirement Income Security Act or ERISA legislation, which is discussed later in this lecture. In these plans, the employer administers the plan and assumes all the risk for the health care expenditures of its employees. An employer may contract the claims paperwork to a third-party administrator, or TPA . The remainder of this lecture will focus on private health insurance. Government health insurance will be covered in the next lecture. Health IT Workforce Curriculum Version 4.0 10