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Health Insurance Information
What kinds of health insurance are there?
There are essentially two kinds of heath insurance: Fee-for-Service and Managed
Care. Although these plans differ, they both cover an array of medical, surgical
and hospital expenses. Most cover prescription drugs and some also offer dental
These plans generally assume that the medical professional will be paid a
fee for each service provided to the patient. Patients are seen by a doctor
of their choice and the claim is filed by either the medical provider or the
- Managed Care
More than half of all Americans have some kind of managed-care plan1. Various
plans work differently and can include: health maintenance organizations
(HM0s), preferred provider organizations (PPOs) and point-of-service (POS)
plans. These plans provide comprehensive health services to their members
and offer financial incentives to patients who use the providers in the
What is 'long-term care'?
Because of old age, mental or physical illness, or injury, some people find
themselves in need of help with eating, bathing, dressing, toileting or
continence, and/or transferring (e.g., getting out of a chair or out of bed).
These six actions are called Activities of Daily Living–sometimes referred to as
ADLs. In general, if you can’t do two or more of these activities, or if you
have a cognitive impairment, you are said to need “long-term care.”
Long-term care isn’t a very helpful name for this type of situation because, for
one thing, it might not last for a long time. Some people who need ADL services
might need them only for a few months or less.
Many people think that long-term care is provided exclusively in a nursing home.
It can be, but it can also be provided in an adult day care center, an assisted
living facility, or at home.
Assistance with ADLs, called “custodial care,” may be provided in the same place
as (and therefore is sometimes confused with) “skilled care.” Skilled care means
medical, nursing, or rehabilitative services, including help taking medicine,
undergoing testing (e.g. blood pressure), or other similar services. This
distinction is important because generally Medicare and most private health insurance pays
only for skilled care–not custodial care.
1 - Source : MANAGED CARE AND THE STATES