Routine professional consultations during illness and outpatient hospital care, including emergency-room visits
Inpatient services include bed and board, routine care. Private rooms only when medically necessary
Auto and air transportation
Services include children’s immunizations and annual physicals, gynecological examinations, prenatal and well-baby care, mammograms every two to five years, cholesterol screening.
Inpatient stays at rehabilitation facilities as alternatives to hospitalization, up to 100 days a year; phased in by 1996-2000
As alternative to hospitalization; reassessment after every 60 days; additional stays approved only to prevent institutional care
Routine ear and eye exams; children’s eyeglasses
Prescribed outpatient lab and radiological services
Outpatient physical, occupational and speech therapy to restore function or minimize limitations from illness or injury; reassessment after each 60 days of therapy; additional therapy approved only if patient’s function is found to be improving
Initially only preventive care for children under 18 years old; in 2000, preventive care for adults, some restoration and orthodontia only to avoid reconstructive surgery
Cost will vary from $5 per prescription to $250 annual deductible
As an inpatient alternative to hospitalization for the terminally ill
Up to 60 days of care at inpatient facilities, 30 days per episode of illness; 30 visits to a psychotherapist; no limit on other outpatient services. In 2000, 90 days of care at inpatient facilities; no limits on psychotherapy visits
Medicine the old-fashioned way. You pick any doctor you like–and pay for the privilege. Since this option gives consumers the greatest freedom (and may allow doctors to perform possibly unnecessary services), it osts more than other health plans. it’s expected to be most popular with financially secure Americans who value the relationships they’ve established with their doctors.
Organizations HMOs provide the full range of medical services, either all under one roof or through a network of affiliated doctors working out of their own offices. Similar to one-stop clinics, some HMOs eliminate the element of choice: instead of making an appointment to see your doctor, you simply see whoever is on duty. Others allow you to chose a primary-care physician, who then makes referrals to specialists when necessary.
joint ventures offered by doctors, hospitals and insurance companies, these plans combine elements of the HMOs with some of the freedom of the fee-for-service plans. Enrollees could consult doctors from within the network and pay low co-payments. On occasions when enrollees wish to make appointments with doctors from outside the network, they would pay higher rates similar to those paid by members of fee-for-service plans.
For the first few years of the plan, Medicare would continue to supply the medical needs of senior citizens and the disabled. States would have the option of shifting Medicare participants into health alliances. Low-income Medicaid recipients would join health alliances. Medicaid would survive only for undocumented persons.
Corporations would pay 80 percent of their workers’ insurance premiums, and their employees would pay the remaining 20 percent.
In corporations with fewer than 50 employees, the company would still pay 80 percent and the employee 20 percent, but hard-hit employers would be eligible for government subsidies.
Workers would pay 100 percent of their premiums, but insurance payments would be 100 percent tax-deductible.
Premiums for unemployed workers without resources would eventually be paid by the government. Initially, Medicaid and Medicare would pick up the slack.
