Employer-based self-insurance has become a common form of group health insurance coverage.

Many employers enter into administrative service only (ASO) contracts with private insurers and fund the plans themselves. The private insurers administer self-insurance plans on behalf of the employers.

Blue cross and blue shield plans Blue cross and blue shield (BC/BS) plans, also known as the blues, were the first prepaid health plans in the united states. Originally, blue cross plan covered hospital care and blue shield plans covered physicians services. The first blue cross plan was created in 1929. In 1939, a commission of the American hospital association(AHA) adopted the blue cross national emblem for plans that met specific guidelines. The blue cross association was created in 1960, and the relationship with the AHA ended in 1972. The first blue shield plan was created in 1939, and the associated medical care plans (inter known as the national association of blue shield plans) adopted the blue shield symbol in 1948. In 1982, the blue cross association and the national association of blue shield plans merged to create the blue cross and blue shield association. Today, the blue cross and blue shield association includes over 60 independent, locally operated companies with plans in 50 states, the district of Columbia, and Puerto rico. The blues offer health insurance to individuals, small businesses, seniors, and large employer groups. In addition, federal employees are eligible to enroll in the BC/BS Federal Employee Program (FEP) (also called the BC/BS service benefit plan). The plan offers the two product to federal employees: A preferred provider organization (PPO) plan, in which healthcare provider provide healthcare services to members of the plan at a discounted rate. A point-of-service (POS) plan, in which subscribers are encouraged to select providers from a prescribed network but are allowed to seek healthcare services from providers outside the network at a higher level of copayment.

Government-sponsored Healthcare Programs The federal government administers several healthcare programs. The best known are medicare and Medicaid. The medicare program pays for the healthcare services provided to social security beneficiaries 65 years old and older as well as permanently disabled people, people with endstage renal disease, and certain other groups of individuals. State governments work with the

federal Medicaid program to provide healthcare coverage to low-income individuals and families. In addition, the federal government offers three health program to address the needs of military personnel and their dependents as well as native Americans. The civilian health and medical program-veterans administration (CHAMPVA) provides healthcare service for dependents and survivors of disabled veterans, survivors of veterans who died from servicerelated conditions, and survivors of military personnel who died in the line of duty. TRICARE(formerly CHAMPUS, the civilian health and medical program-uniformed services) provides coverage for the dependents of armed forces personnel and retirees receiving care outside a military treatment facility. The Indian health service(IHS) provides federal health services to American Indian and Alaska natives. Medicare The original medicare program was implemented on july 1, 1966. In 1973, medicare benefits were expanded to include individuals of any age who suffered from a permanent disability or end-stage renal disease. For Americans receiving social security benefits, medicare automatically provides hospitalization insurance (HI) (medicare part A). it also offers voluntary supplemental medical insurance(SMI) (medicare part B) to help pay for physicians services, medical services, and medical-surgical supplies not covered by the hospitalization plan. Enrollees pay extra for part B benefits. To fill gaps in medical coverage, most medicare enrollees also supplement their benefits with private insurance policies. These private policies are referred to as Medigap insurance. Medicare Advantage (formerly Medicare+Choice) was established by the balanced budget Act(BBA) of 1997 to expand the options for participation in private healthcare plan. According to CMS, approximately 19 million Americans were enrolled in the medicare program in 1966. In 2005, approximately 40 million people were enrolled in parts A and/or B of the medicare program, and 6,4 million of the enrollees participated in a medicare advantage plan Medicare part A Medicare part A is generally provided free of charge to individuals age 65 and over who are eligible for social security or railroad retirement benefits. Individuals who do not claim their monthly cash benefits are still eligible for medicare. In addition, workers (and their spouses) who have been employed in federal, state, or local government for a sufficient period of time qualify for medicare coverage beginning at age 65. Similarly, individuals who have been entitled to social security or railroad retirement disability benefits for at least 24 month and government employees with medicare coverage who have been disabled for more than 29 months are entitled to part A benefits. This coverage also is

provided to insured workers (and their spouses) with end-stage renal disease as well as to children with end-stage renal disease. In addition, some otherwise-ineligible aged and disabled beneficiaries who voluntarily pay a monthly premium for their coverage are eligible for medicare part A. The following healthcare services are covered under medicare part A: inpatient hospital care, long-term care, skilled nursing facility (SNF) care, home health care, and hospice care. (See table 14.2) inpatient hospital care and long-term care are paid for under medicare part A when such care is medically necessary. An initial deductible payment is required for each hospital admission, plus copayments for all hospital days following day 60 within a benefit period. Each benefit period begins the day the medicare beneficiary is admitted to the hospital and ends when he or she has not been hospitalized for a period of 60 consecutive days. Inpatient hospital care is usually limited to 90 days during each benefit period. There is no limit to the number of benefit periods covered by medicare hospital insurance during a beneficiarys lifetime. However, copayment requirements apply to days 61 through 90. When a beneficiary exhausts the 90 days of inpatient hospital care available during a benefit period, a nonrenewable lifetime reserve of up to a total of 60 additional days of inpatient hospital care can be use. Copayments are required for such additional days. SNF care is covered when it occurs within 30 days of a three-day-long or longer hospitalization and is certified as medically necessary. The number of SNF days provided under medicare is limited to 100 days per benefit period, with a copayment required for days 21 through 100. Medicare part A does not cover SNF care when the patient does not require skilled nursing care or skilled rehabilitation services. Care provided by a home health agency (HHA) may be funished part-time in the residence of a homebound beneficiary when intermittent or part-time skilled nursing and/or certain other therapy or rehabilitation care is needed. Certain medical supplies and durable mediczl equipment(DME) also may be paid for under the medicare home health benefit. The medicare program requires the HHA to develop a treatment plan that is periodically reviewed by a physician. Home health care under medicare part A has no limitations on duration, no copayments, and no deductibles. For DME, beneficiaries must pay 20 percent coinsurance, as required under medicare part B. Terminally ill persons whose life expectancies are six month or less may elect to receive hospice services. To qualify for medicare reimbursement for hospice care, patients must elect to forgo standard medicare benefits for treatment of their illnesses and agree to receive only hospice patient requires treatment for a condition that is not related to his or her terminal illness, however, medicare does pay for all covered services necessary for that condition. The medicare beneficiary pays no deductible for hospice coverage but does pay coinsurance amounts for drugs and inpatient respite care.