Title: Differentiate among the types of health insurance.
Course: Medical Coding and Billing I (14151-III) > Section: Understanding the U.S. Healthcare System

Differentiation should include

- preferred provider organization (PPO)
- health maintenance organization (HMO)
- Medicare
- Medicaid, managed care organization (MCOs)
- private insurance
- workers’ compensation
- State Children’s Health Insurance Program (SCHIP)
- ACA
- TRICARE
- Railroad Retirement program benefits
- United States of Veterans Affairs benefits
- Medicare Administrative Contractors (MACs).

Where applicable, differentiation should include elements of health insurance:

- Premiums
- Deductibles
- Co-insurance
- Copayment
- Health savings accounts (HSA)

Process/Skill Questions

- Why are there different types of health insurance?
- Who determines who is eligible for various types of health insurance? What happens to patients who are not insured?
- How are Medicare and Medicaid similar? How are they different?
- How has the development of managed care influenced the cost of medical care?
- What is the difference between an HMO and a PPO?
- What is the purpose of workers’ compensation?
- What does the ACA provide related to coverage, cost, and care?
- What happens to citizens who do not comply with the “minimum essential” health insurance coverage requirement?
- What is a MAC? How is it different from traditional Medicare?