Describe the differences between government and commercial insurance?
What requirements that would make a patient eligible for each type?
Where? Governmental insurances vary per state, as do private insurance. "Commercial" insurance refers to insurance purchased by businesses.
Eligibility for governmental insurances – which usually means health insurance or unemployment insurance – are found with a simple search, naming the state and what you’re interested in.
For private insurance, it varies SO wildly, that even within one state there’s no "one" set of rules.
Is this a homework assignment??
October 12th, 2009 at 11:19 pm
The key word, "patient," tells all. YOU’RE talking about HEALTH benefits. Here’s the deal:
Except as state regulations may force a private carrier to insure patients, the private (commercial) insurance can pick or choose which people it wants to insure -ruling out the sick ones and giving discounts to the healthy ones.
The government insurance is PAID for by the government, from money paid into social security (or otherwise). The benefits themselves are also determined by the government: medicare, medicaid, etc. The DELIVERY and administration of the benefits (the paperwork, in other words) is handled by a private, commercial company across the country. Mutual of Omaha is a big player for Federal programs, and various companies compete for the business at the state level.
Some states allow several companies to offer competing programs within a single state. The patient (usually someone on disability or welfare) can choose among various options, selecting one because, perhaps, it has more doctors nearby.
In between all this are the "Blues," Blue Cross (doctors) and Blue Shield (Hospitals) which usually operate under a state charter of some kind, and derive most of their business writing group plans for employers. Often, they have underwriting requirements, so some people (the sick ones) can’t get coverage from them. But in some states, they periodically offer "open enrollement," and during those periods anybody can sign up.
It is, unfortunately, a complicated mess.
References :
October 12th, 2009 at 11:42 pm
Where? Governmental insurances vary per state, as do private insurance. "Commercial" insurance refers to insurance purchased by businesses.
Eligibility for governmental insurances – which usually means health insurance or unemployment insurance – are found with a simple search, naming the state and what you’re interested in.
For private insurance, it varies SO wildly, that even within one state there’s no "one" set of rules.
Is this a homework assignment??
References :