The USA insurance system has a unique history and structure. The rapid growth of the economy and accumulation of capital created all the necessary conditions for the insurance institution development. The insurance system, which directly depends on both the economy and welfare of citizens, is an indicator of the overall financial condition of the country. In the USA, insurance agencies have five main functions being different in their directional properties: saving, investment, risk, preventive, and control. There are a large number of various companies that perform these functions. The purpose of this paper is to define the difference between Medicare and Medicaid insurance programs and discuss the impact of health care reform initiatives on both of them.
The USA insurance system, in comparison with other countries, is continually developing and improving. The insurance must be issued for all family members, including children. Pregnant, adopted children up to 26 years old and large families can count on help in paying insurance. Most states have various insurance programs for children that are paid by the state and charities. According to Ward (2017), a child receives such insurance if he or she is a US resident under the age of 18 and is eligible for the insurance company. Children’s coverage usually includes the services of speech therapists, ophthalmologists, and dentists.
Medicare and Medicaid are the most available insurance programs for the elderly and people with low income. Medicare is a federally-funded nationwide program in comparison with Medicaid, which is also state-funded. The latter involves insurance for citizens with low income and livelihoods, while Medicare is provided for people over 65 years old. As for the payment, Medicare assumes deductibles and partial fee of coverage cost. People being insured in Medicaid programs pay very little or no part of full coverage.
The citizens who use Original Medicare have drug coverage through Medicare Part D private plans. Moreover, additional medical insurance in the form of a Medigap insurance policy through private companies is offered. The second option for getting Medicare is through an individual plan known as the Medicare Advantage Plan. Medigap policies cannot supplement these plans but usually include drug coverage. There are over 90 Medicare Advantage Plans serving New York, Long Island, and Westchester. It is possible to note that the mentioned programs have several similarities, including outpatient and inpatient treatment, prescription drug coverage, and privileges for people with disabilities (Hindsight 101, 2017). The difference between the two programs is significant, and all the details set forth above must be taken into account. The awareness of particulars provides an opportunity to choose the required care, change and improve the previously selected program option, and get additional benefits.
How Medicare changes society
The Medicare program development is based on the changing needs of society and the progressive growth of the insurance market as a whole. Researchers note that the emergence of new drugs, competitive insurance companies, and the development of digital technologies are gradually eliminating the concept of the profitability of diagnoses (Cappiello 101). Unfortunately, some unscrupulous companies use the idea of this term to obtain more significant benefits and take advantage of long-term cooperation. With an increase in the level of education of citizens, as well as access to Internet resources, it became possible for Medicare to meet the needs of society. The specialists compile analytical data and adjust risks in order to provide better services for older adults. Technological changes contribute to the development of favorable advantages in the appointment and purchase of necessary medicines, the care organization for people with reduced mobility. Accordingly, the payment schemes are legibly systematized and regulated in accordance with generally accepted standards.
Impact of reform initiatives
The influence of companies dominating the insurance market covers more than half of the country’s population. According to Carey (2017), Aetna Inc. is an indisputable leader and serves almost a third of the country’s population. No doubt, applying for alternative budget companies makes it possible to save money, but requires maximum awareness. Researchers note that numerous debates are underway to resolve the issue of the insurance system unification (Carey, 2017). The impact of health care reform initiatives is associated with the dispute about the transition to universal insurance. Comprehensive requirements on the health insurance coverage, changes in Affordable Care Act, and extensive regulations on medical care are the main criteria of health care reform initiatives having an impact on Medicare and Medicaid. The specific narrowly specialized challenges still take place and are discussed in detail with insurance agents.
The insurance policy in the United States is a security criterion for an individual citizen of the country and the entire state as a whole. Following the foregoing, United States law is designed to provide comprehensive support to the population in this matter. Independent study of all insurance issues or contacting specialists in obtaining a policy is a more practical and reliable choice. Provided that the long-term implementation of the Medicare and Medicaid programs, the country’s vulnerable population receives high-quality medical care, spending a minimum of accumulated savings.
Cappiello, A. (2018). Technology and the Insurance Industry. Pisa, Italy.
Carey, C. (2017). Technological change and risk adjustment: benefit design incentives in Medicare Part D. American Economic Journal: Economic Policy, 9(1), 38-73.
Hindsight 101. (2017). Medicare vs Medicaid: why you need to know the difference [Video file]. Web.
Ward, L. (2017). Improving outcomes by centralizing data for young patients in Houston. Modern Healthcare, 47(8), 20-22.