Family Health Insurance

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

Quality Health Care for the Uninsured children in the United States in comparison to Health Care for children in Canada.

Long time ago, there was no need for health insurance in America, as doctors had many clients because their services were not so expensive and in some cases in rural areas, people could pay by giving other items. Doctors were not as knowledgeable as they are nowadays to care for the sick, therefore this didn't have much effect then on the patients, as they were treated for the basic illnesses.

Insuring health coverage for dependent adults until age 26 aims to decrease the great number of young adults uninsured out of college, and increases the number of young adults visiting the hospital for major to minor health issues. Unfortunately, before this extension was made, many dependent young adults opted out of medical visits because the fear of the costly visit. Approximately 13.7 million young adults were in uninsured in 2008, which was a jump from 10.9 million in 2000 (Collins, 2010). With this law being made under the Affordable Health Care Act, young adults should feel more comfortable to visit the hospital for minor health issues, in order to prevent major health issues.

Zach’s major medical insurance coverage seems inadequate. Based on Zach’s recent accident, he must pay about 40% of major medical costs. Zach should increase his major medical coverage. However, to get more attractive deductibles, coinsurance, and internal limits, he would have to pay additional premiums. The amount

Why do people remain uninsured? According to the Kaiser Family Foundation (KFF), “Even under the Affordable Care Act (ACA), many uninsured people cite the high cost of insurance as the main reason they lack coverage”(Key Facts) “In 2015, 46% of uninsured adults said that they tried to get coverage but did not because it was too expensive”(Key Facts). Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage. Some people who are eligible for financial assistance under the ACA may not know they can get help, and others may still find the cost of coverage too expensive.

Managed care has become so popular because of its capabilities to deliver health care at

Usually Medicaid beneficiaries have one or more additional sources of coverage. Medicaid is a federal and state medical assistance program; and coverage will vary from state to state. The program provides medical care for low-income families; with emphasis on children, pregnant women, elderly, disabled, and parents with dependent children who do not have any other way to pay for healthcare. Third Party Liability (TPL) is the legal obligation of certain individuals, entities, insurers, or programs to pay part or all of expenditures for medical assistance furnished under a Medicaid state plan. Therefore, by law, any and all other available third-party resources must meet their legal obligation to pay claims before Medicaid pays for the care

Through the years people in the Unites States have struggle with issues dealing with having health coverage. In March 2014 Obama care also known as Affordable Care Act was sign into law making it possible for the lower and middle class to be able to afford health insurance. The affordable care act was in congress from 2009 to 2010.With the act been pass it made it easier for the people to qualify and get help and pay so little with no extra cost. Even thought the insurance is not free it is now affordable for people so now people have a wider range of coverage options. With the affordable care act been pass they are hoping with the affordable screening and preventive services they can be more proactive with people’s healthcare and delay

With the development of public health in U.S., the health insurance coverage has benefited most American citizens. But there is a large ethnic minority group in the U.S. which is most likely to lack coverage, Hispanics. Concerning Latinos with health, there is a barrier for Latinos to get health care. Latinos who are not citizens or permanent residents do not have health insurance, even though PPACA legal non-citizen residents will be able to buy insurance. Without health insurance, Hispanics face health disparities that make them suffer with bad health outcomes and having a higher illness rates.

Medicare is a health insurance program purposely created for people over sixty five (65) years of age. However the service is open to people with certain disabilities or permanent kidney failures. The process of choosing the right Medicare involves having to weigh different plans on account of benefits of their cover. Different types of Medicare plans are important in: Inpatient hospital care, outpatient services, doctor visits, home health care, prescription drugs, and care in a skilled nursing facility among others. In addition, the program covers the cost of health care but does not cover all medical expenses including cost of long term care. If one ought to choose an original Medicare coverage, one may buy a Medicare supplement policy from a private insurance company to aid in coverage of costs that are not supported by Medicare. Most of these Medicare expenses are covered by a part of the pay role offered to workers by their employer. This paper covers different Medicare plans; A, B, C, D and their influence towards my decision on the best preferred option.

The working uninsured refers to families or groups of individuals who have no health insurance, most of this individuals are also know to belong to low-income earning family. Although most of them hold a job, they have a job with very low income and are unable to afford to pay premiums for insurance coverages provided by employees or personal insurance. Eligibility for health insurance benefit could also be based on employment status, individuals who work part-time in most cases are not eligible for or afford employee provided coverage, most individuals belonging to this population work every day basically just to meet their basic needs which primarily includes; shelter, food and clothing. Uninsured individuals includes mostly low-income individuals and families who are not eligible to receive state welfare benefit benefits such as Medicare and Medicaid.

Mrs. Jones, like many older adults, is on a fixed income, has Medicare for health coverage, but lacks prescription drug coverage. She was recently prescribed a new medication by her physician, which she cannot afford. As Mrs. Jones nurse, it is my responsibility to advocate for her by providing education and sharing information on the multiple different avenues available to decrease the cost of the medication prescribed. I will identify three strategies in which I can help Mrs. Jones afford her medication. First, I will provide education on her insurance plan and explain Medicare Drug Plans and their enrollment process. Secondly, I will identify a financial assistance program which she might qualify for. Finally, I will identify different ways to lower the cost of the medication such as coupons, drug discount cards, switching to a generic medication, and store programs ("Prescription Drug," 2014). All of these options are a solution to Mrs. Jones problem. In the meantime, it may be beneficial to obtain free samples from the physician 's office if possible, but this only makes sense if there is a strong likelihood that she will eventually be able to afford the new medication.

TRICARE Health Plans is the replacement for CHAMPUS which was the provider of health care services for military dependents. TRICARE not only replaced CHAMPUS but its purpose was also to facilitate members with access to better health care. Unfortunately, TRICARE has gone through many changes and upheavals since its inception in 1997. First, they began by dividing the company into regions. Each member was placed into a region based on where the military member was stationed. If the member was stationed in Maryland then his family belonged to the East Region. Unfortunately, there were many problems with this plan. First, some military members and their families did not live in the same regions. Therefore, the families either had to travel

Medicaid-focused managed care has become progressively imperative to state Medicaid organizations. With healthcare reform and the enactment of the Patient Protection & Affordable Care Act (ACA) in 2010, Medicaid will possibly be the main insurer for increasing coverage to millions of low-income, uninsured Americans. Medicaid, a government funded health insurance plan overseen by the state, has supplied coverage for people with disabilities, children, pregnant women, seniors, and the indigent. Managed care plans have aimed to contract with healthcare providers and provide coverage at reduced costs (Smith & Coustasse, 2014). The ACA has helped people become eligible for Medicaid who otherwise would not be able to afford health insurance. There will be more equality between genders, before ACA, the majority of beneficiaries were female. Even though ACA has helped more people become eligible for Medicaid, there are also challenges that have risen due to this as well. The focus of this paper is on the challenges regarding Medicaid managed care and how they can be resolved. The first area discussed will be the history behind Medicaid. Then move on to the challenges of the Medicaid Managed Care Program and how they can be resolved as well as the possible solutions.