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Essay On Healthcare Insurance

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Each state has their own policies for Medicaid eligibility, services and payments. Medicaid plans have three eligibility groups such as categorically needy, medically needy and special groups. Children's Health Insurance Program (CHIP) is a program that offers health insurance coverage for uninsured children under Medicaid. If Medicaid does not cover a service, the patient may be billed if the following conditions have been met such as the physician informed the patient before the service was performed that the procedure was not covered by Medicaid and if the patient has signed an Advance beneficiary Notice form. However, there are also conditions where the patient cannot be billed if necessary preauthorization was not obtained or service …show more content…

Tricare Prime is a managed care plan similar to an HMO. This plan has Tricare Prime Remote, Tricare Prime Overseas and Tricare Global Remote Overseas. Tricare Extra is an alternative managed care plan for individuals who want to receive services primarily from civilian facilities and physicians rather than from military treatment facilities. Tricare for Life is a plan for beneficiaries who are both Medicare and Tricare eligible. Tricare Reserve Select is a premium based health plan available for purchase by certain members of the National Guard and Reserve activated on or after September 11,2001. Tricare Young Adult is a plan that can be purchased by qualified adult children after their regular Tricare coverage ends at age of twenty-one. Tricare is a secondary payer in almost all circumstances except Medicaid. The Civilian Health and Medical Program of the Department of Veteran Affairs (CHAMPVA) is the government’s health insurance program for the families of veterans with hundred percent service related disabilities. CHAMPVA provides coverage for most medically necessary services such as surgical procedures, anesthesia, chemotherapy, physical therapy, speech therapy, mental healthcare, prescription medications, maternity care, family planning, immunizations, durable medical equipment, hospice services and much more. CHAMPVA is usually the secondary payer except Medicaid and supplemental policy.

An Explanation of Benefits (EOB) is a

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