Gov in many health maintenance organizations hmos you

healthcare.gov, “In many Health Maintenance Organizations (HMOs), you need to get a
referral before you can get medical care from anyone except your primary care doctor. If you

Task 3 Healthcare Financing 4
don’t get a referral first, the plan may not pay for the services.” ("Referral - HealthCare.gov
Glossary", n.d.)
c. Coverage for preexisting conditions in Germany: Medical coverage for those with diagnosed
medical conditions cannot be denied. Health insurance coverage in Germany for those with
pre-existing medical conditions may come at a higher cost for the resident.
Coverage for preexisting conditions in United States: The Affordable Care Act that was enacted
in 2010 made it illegal to deny healthcare coverage to any person with a pre-existing medical
condition. This person also cannot be charged more for their coverage because of their
medical condition(s).
3 . Financial Impact on Patients:
1- Germany : Residents are responsible for paying a portion of the premium that is split with their
employer. For example, according to the film, Sick Around The World, “A worker earning
$60,000 would split a $750 monthly family premium with her employer.” (Palfreman, 2008)
United States - A large amount of health insurance coverage in the United States is employer
related. However, the employers try to maintain the premium cost by continually increasing the
cost-sharing, therefore requiring the employee to contribute more and more. Increased cost can
be seen in higher contributions towards the monthly premium or by offering high-deductible
plans that results in increase out of pocket payments.
2- Germany: Patients can encounter copays for hospital stays, rehabilitation, prescriptions, and
medical devices. “Copayments include EUR 5.00 to EUR 10.00 (USD6.36 to USD 12.72(per
outpatient prescription, EUR 10.00 per inpatient day for hospital and rehabilitation stays (for the