ATI Fundamentals for Nursing ATI

Medicare - for clients over age 65 and/or with permanent disabilities. premiums applied as insurance program reimburses providers based on DRGs. Premiums applied as Managed Care Organizations (MCOs) provide enrolled clients with comprehensive care overseen by a primary care provider. Is federally funded. Medicaid - for clients with low income. is federally funded and individual states determine eligibility requirements. Traditional Insurance - reimburses for services on fee-for-service basis. Managed Care Organizations (MCOs) - comprehensive care is overseen by a primary care provider & focuses on prevention and health promotion Preferred Provider Organizations (PPOs) - client chooses from a list of contracted providers. using non-contracted providers increases the client's out of pocket costs Exclusive Provider Organizations (EPOs) - the client chooses from a list of providers within a contracted organizatio