Learning Objectives
In this section, the student will:
- Describe the relevance of insurance in care coordination
- Describe the basics of health insurance and paying for healthcare services including the differences in Medicare and Medicaid
- Differentiate between types of insurance, entitlement programs, and funding sources that pay for healthcare and how to advocate on the client’s behalf
- Differentiate between the various funding sources that pay for health care
Resources
- How to Get or Stay on a Parent’s Plan Healthcare.gov
A website providing information on keeping or obtaining coverage through a parent’s plan, as well as listing other resources for obtaining coverage.
- Medicare Medicare.gov
The homepage for the Medicare program hosting links to many useful resources, Medicare-covered providers, news archives, and other information about the program.
- Medicaid Medicaid.gov
The main resource for information on the Medicaid program, how to apply for coverage, what services are included, popular pages and fact sheets, and other helpful links.
- Children’s Health Insurance Program (CHIP) Medicaid.gov
Additional information about the availability of children’s health insurance programs through Medicaid.
- Veteran’s Health Administration U.S. Department of Veteran Affairs
Resources for those who have served in the military, or their families, with regard to health care benefits, as well as local resources and/or programs.
TRICARE is the health care program for uniformed service members and their families around the world. This webpage serves as a multi-resource home for useful information.
- FAQs about COBRA Continuation Health Coverage Employee Benefits Security Administration, US Department of Labor
A list of frequently asking questions regarding COBRA insurance coverage, a provision which requires group health plans to provide temporary continuation coverage for people who are retired, unemployed, disabled, or in transition, until they find permanent coverage.
- Health Insurance Marketplace healthcare.gov
The official health insurance guide to the insurance marketplace, providing tips, eligibility, and deadlines to applying for health insurance coverage.
- Health Maintenance Organizations (HMOs) healthcare.gov
A short glossary definition of the term HMO.
- Preferred Provider Organizations (PPOs) healthcare.gov
A short glossary definition of the term PPO.
- The Uniform Glossary Handout U.S. Department of Health and Human Services
A handout providing a glossary of health coverage and medical terms.
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Open in new tab - Navigating the Health Care System: What to know and do to ensure effective care the National Alliance for Caregiving and the Metlife Mature Market Institute, 2013.
A useful guide to help patients and their families understand the health care system and how best to receive the proper care.
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- “Medicare: What Is It?” VeryWell.com
This website details the basics of medicare coverage including what it is, how it started, how it’s organized and how it is funded.
The homepage for resources regarding Medicare, Medicaid, CHIP, private insurance information, data and statistics information, and education and outreach.
This short article identifies and explains the key differences between the Medicaid and Medicare programs.
- How to Appeal an Insurance Company Decision healthcare.gov
A short overview on how to appeal an insurance company decision regarding coverage or paid claims.
- Emergency Medical Treatment and Labor Act (EMTALA); from the American College of Emergency Physicians
- Free or Reduced-cost Hospital Care in Washington State; from Northwest Health Law Advocates
