Medicare
History
Medicare insurance is a United States national government program that started in 1965 and is currently under the Centers for Medicare and Medicaid Services. This program mainly focuses on people ages 65 and above and specific younger individuals with disabilities (Berchick et al., 2019). It also provides coverage for persons with final-stage renal diseases and patients with permanent kidney failure making dialysis a necessity or requiring a kidney transplant.
How it works
To get coverage, there are two main ways to consider the Original Medicare or the Medicare Advantage. In the Original Medicare, you pay for services as you receive them by co-insuring with them. A deductible is paid at the beginning of each year, and 20% of the cost of a Medicare-approved service is usually paid when services are provided. The Original Medicare covers the majority of costs but not all, and in such cases, supplemental plans have been provided to help cover the remaining costs. One of the supplemental plans is the Medicare Advantage which helps to pay for drug prescriptions needed by a patient.
Consumer Rights and Protections
Everyone with Medicare is entitled to certain rights and protections outlined to protect them when receiving health care, against unethical practices, protect their privacy and ensure that all healthcare services provided by the law are received (Berchick et al., 2019). Patients with Medicare also have the rights to be treated with dignity and respect at all times, be protected from discrimination, be given information in a way that they understand by all medical staff and Medicare themselves, have all their questions answered, and receive simple, clear information to help them make good health decisions.
Concerns
Although Medicare provides significant benefits, there are still a few concerns about the program. The program has a high deductible for in-patient care and does not pay for long-term care costs and other needs like glasses and hearing aids for patients. This eventually makes health expenses high for some individuals if they do not get supplemental coverage (Holahan & McMorrow, 2019). Future generations are most likely to face challenges financing their health care due to the annual medical costs increase. The rising medical costs also put much pressure on Medicare spending.
Medicaid
History
Medicaid insurance is health coverage provided to American citizens, including adults with minimum wage, children, expectant women, persons with disabilities, and the elderly (Berchick et al., 2019). This program was authorized and signed into law alongside Medicare in 1965. It is funded by both the federal government and states to be able to provide health coverage for low-income citizens (Zheng et al.,2018). The rules for determining eligibility for benefits provided for this program have been standardized by the Affordable Care Act since 2014.
How It Works
Entitlement to Medicaid is based on an American citizen being in one of the eligible groups. The groups are low-income families, pregnant women and children, and people receiving Supplemental Security Income. Although these are the groups recognized by the federal government, state governments have the options to cover other groups like children in foster care who would otherwise not be eligible.
Medicaid pays for expensive long-term care for millions of seniors and disabled people of all ages in nursing homes and in the community. Medicaid supplements the private insurance market by serving high-risk individuals, giving coverage to many uninsured persons who were previously denied coverage under the private, primarily employment-based health insurance system due to low income, poor health, or disability (Zheng et al.,2018). Medicaid also helps poor-income Medicare beneficiaries cater for premiums and co-insuring and provides long-term services and supports that Medicare does not cover.
Consumer Rights and Protections
Consumer rights and protections in this program include the right to appeal to the plan in fair state hearings and access to quality health care for all individuals with low income and those minority communities. Medical has achieved its goal of improving health care among the poor. Despite this, Medicaid does not serve all poor since eligibility is very limited and neither does it meet all the healthcare needs of eligible people.
Concerns
Employer-sponsored retirement plans health covers are the key source of supplemental coverage for Medicare recipients. However, these benefits have eroded over time as employers struggle to deal with rising healthcare costs. Beneficiaries with very low incomes depend on Medicaid to complement Medicare, and Medicaid has become a critical source of coverage for nursing home care (Zheng et al.,2018). However, beneficiaries must typically spend nearly all their entire life savings in order to be eligible for Medicaid assistance. Future initiatives are to expand the eligibility for the program and add more beneficiaries to the program.
Employee Group Health Plan
History and How It Works
These are health plans purchased by employers to be offered to eligible employees and their co-dependents. Employee group health plans are important because they help provide security in case of unplanned medical expenses like emergency healthcare (Berchick et al., 2019). The employer is charged less premium because the risk is spread between a large group of people. The benefits of this type of insurance plan can sometimes be extended to the employee’s immediate family.
Consumer rights and protections
Consumer rights and protections for this health policy include the right to receive simple, clear, and easy-to-understand information about your health benefits, protection against employer retaliation, and the right to appeal the health insurance company’s decision. The health insurance company has to provide you with information about the appeal process and ensure it is a fair process.
Concerns
Employee group health plans have fewer complications because they serve a large group of individuals. They also do not have strict restrictions on pre-existing conditions compared to individual health plans. This employee health insurance policy is very beneficial to employees and their families, but one should not have it as their primary health cover. This is because the benefits of this policy can always be cut short when someone leaves their place of employment.
The Market Place Plans
History and How It Works
These are health insurance plans that have been designed to meet the needs of an individual while still being on a budget. They offer similar sets of essential health benefits, including consultation services, preventive treatment, in-patient treatment, drug prescriptions, and others (Duggan et al., 2019). Consumers are then given the plans to compare based on benefits, quality, price, and other essential medical benefits to them before making a decision on which plan they prefer to purchase.
Consumer rights and protections
Consumers seeking this type of healthcare cover have the rights and protections to be covered even if they have pre-existing medical conditions, to receive free preventive care, to be given easy-to-understand information regarding their health benefits, and finally, they are protected from an unreasonable additional increase in rates (Duggan et al., 2019). Consumers also have a right to appeal a health insurance company’s decision, just like all the other healthcare plans.
Concerns
There are quite a few limitations related to marketplace health plans, and this includes them not being expensive for some individuals. People settle to pay a lot of money for plans that include benefits like maternity, and yet they may not need them (Duggan et al., 2019). Also, some states still charge tax penalties despite federal tax penalties being removed. Finally, the search for the perfect health coverage plan can be hectic and stressful, with limited periods of enrolment and a lot of coverage options that confuse people.
Paying out of the pocket
History and How It Works
This is when an individual pays for all their medical expenses from diagnosis, treatment, and medication using their own money with no help from insurance companies. Individuals in this group range from wealthy people who have no need for insurance plans to individuals not eligible for medical insurance and those paying for non-insured medical services like plastic surgeries.
Concerns
In this type of health plan, the quality of health care one is likely to receive depends on their financial ability. The more money paid, the higher the quality of health care accorded to an individual. Concerns with this type of healthcare plan are the uncertainty of finances being available at all times to cater to medical expenses and the bias of healthcare quality based on how much money one can be able to pay. Uninsured people’s financial well-being can be jeopardized by medical bills (Billig et al., 2020). Non-insured adults are more likely to experience negative outcomes as a result of medical bills, such as depleting savings, struggling to pay for necessities, taking loans, or having medical expenses sent to collections, resulting in medical debt (Billig et al., 2020).
References
Berchick, E. R., Hood, E., & Barnett, J. C. (2019). Health insurance coverage in the United States: US Department of Commerce.
Billig, J. I., Chen, J. S., Lu, Y. T., Chung, K. C., & Sears, E. D. (2020). The economic burden of out-of-pocket expenses for plastic surgery procedures. Plastic and reconstructive surgery, 145(6), 1541-1551. Web.
Brooks-LaSure, C., Fowler, E., Seshamani, M., & Tsai, D. (2021). Innovation at the Centers for Medicare and Medicaid Services: a vision for the next 10 years.
Cutler, D. M., & Zeckhauser, R. J. (1998). Adverse selection in health insurance. In Forum for Health Economics & Policy (Vol. 1, No. 1). De Gruyter.
Duggan, M., Goda, G. S., & Jackson, E. (2019). The effects of the Affordable Care Act on health insurance coverage and labor market outcomes. National Tax Journal, 72(2), 261-322.
Holahan, J., & McMorrow, S. (2019). Slow Growth in Medicare and Medicaid Spending per Enrollee Has Implications for Policy Debates. Urban Institute.
Zheng, N. T., Li, Q., Hanson, L. C., Wessell, K. L., Chong, N., Sherif, N.,… & Rokoske, F. (2018). Nationwide quality of hospice care: findings from the Centers for Medicare & Medicaid Services hospice quality reporting program. Journal of Pain and Symptom Management, 55(2), 427-432. Web.