health care insurance programs
There are various health care insurance programs, either publicly funded or private ones. Their principal responsibility is to improve the health and functioning of the population. Of focus will be a comparison between Medicare, Medicaid, and HMO.
Medicare
The insurance is funded by the federal income taxes, payroll taxes by employers, and the beneficiary premiums. It’s mainly meant for people over the age of 65 years who have been residents for more than five years and younger people who are disabled. The Medicare premiums, deductibles, and copayment rates are adjusted yearly, depending on the social security act. They consist of four parts, A- hospital insurance, B- Medical services insurance, C- Medicare health plans, and D- prescription drugs. Part A covers an inpatient cost, skilled nursing facilities, and some services in-home health care. When admitted for the first 60 days the beneficiary pays a fee of $1408, $352 for 61st to the 90th day and $704 per day for lifetime reserve days.
Medicaid
Funding for this insurance policy is by the state and federal governments to cover health costs and long term care for low-income individuals and families. Those eligible for the service are mainly determined by ones Modified Adjusted Gross Income, and the requirements vary in different states. It’s critical to note that the beneficiary must be a resident of the state in which they are applying, and they should also be a citizen of the USA. The state is responsible for making payments to the healthcare providers either through prepayment arrangements or as a fee for service agreements. Medicaid does cover prescription drug fees for its beneficiaries through prescription limits, cost-sharing, restriction of access to some drugs, and a list of medications that the insurer will cover.
Health Maintenance Organization.
This type of health insurance plan is where an interested individual pays a monthly or annual fee to access a wide range of health services from in-network specialists, hospitals, clinics, and pharmacies. It exists as two models the network model and the group model where their difference is how the specialist hare employed. When seeking a service, the beneficiary pays a small copay fee of $10 to $30 while the HMO covers the rest, there are capitation arrangements present to reimburse the physicians. A member selects a specific primary care physician who acts as a referral when they need to see a specialist of any other doctor unless it’s an emergency. The services offered often require pre-approval. Most prescription drugs are covered, and it does not cover instances where the patient receives care from outside the network the services unless they are in an emergency. The plan includes case management for chronic diseases such as asthma, diabetes, etc. where a case manager is assigned to the patient to monitor and ensure they receive the best service.
Political Impact
The funding and payment policy for Medicare and Medicaid has been contentious ever since its inception. There are numerous political conflicts for both on the prescription drug coverage, who should be included in the insurance and issues on medical care costs. HMOs have a restrictive appearance that has led to lawsuits and political debates on how it prevents necessary care provision even though the beneficiaries have paid for premiums.