Healthcare class discussions

Week 3 Janay

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Janay Davis posted Jan 29, 2021 12:19 AM

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Medicaid is a government funded program that is administered through the state. Each state has different requirements to be eligible for Medicaid. Medicaid is for low income families, children pregnant women, people with disabilities and elderly people. Some requirements include financial, health and employment. According to Medicaid.gov the federal government pays a percentage of expenditures for Medicaid and the state is responsible for the rest.  The government requires that each state covers certain healthcare services to obtain funding. Some of those services include inpatient services, outpatient services, x-rays, and family planning services. So optional coverages are prescription drugs, physical therapy, dental services, and hospice.

Medicare is a program for people 65 and older. Medicare is funded by 2 trust funds according to Medicare.gov. The 2 trust funds are Hospital Insurance (HI) Trust Fund and Supplementary Medical Insurance (SMI) Trust Fund. The HI trust is funded by payroll taxes from employees, employers, self-employed people, and other sources. This trust pays for Medicare Part A which includes inpatient care, hospice, and home health care.  SMI trust is funded by premiums and funds authorized by congress. This trust pays for Medicare Part B and Part D.

Private health insurance is paid for by the employer and the employee. Some private insurance companies are Blue Cross and Blue Shield and United Healthcare. With private insurance you must pay premiums and co-pays. What the insurance covers depends on the type of insurance you choose such as high option or low option.

 

 

References

Mandel, I. (2019). Medicare and Medicaid. Salem Press Encyclopedia. Retrieved from  https://eds-b-ebscohost-com.su.idm.oclc.org/eds/detail/detail?vid=2&sid=bf581f8f-0492-46fd-9758-0f4d4f902f8a%40pdc-v-sessmgr06&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=89185589&db=ers

Medicaid.gov (n.d.) Retrieved from  https://www.medicaid.gov/

Medicare.gov (n.d.) Retrieved from  https://www.medicare.gov/

Understanding Health Insurance. (n.d.) Retrieved from  https://www.hcsc.com/understanding-health-insurance/how-insurance-works

 

Week 3 Discussion

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Erin Worrell posted Jan 28, 2021 10:30 PM

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Describe how this insurance is paid for? Who pays for it?

Medicare is funded by the Social Security Administration, Federal Government and taxpayer. Medicaid is a federal matching fund per State Capita income. Medicaid is a medical assistance program usually do not have to pay for medical expenses covered by this program. HMO stands for Health Maintenance Organization, this is a type of managed health care insurance. HMO primary goals are to keep its members healthy. PPO's must have a Personal Care Provider (PCP), be referred to a specialist by a PCP for special treatment, and use a provider in its HMO network (Davis, 2020). 

Who is eligible to have this insurance? Why?

Medicare is for ages 65 and older. Also with disabilities and long term treatments for Dialysis for End Stage Renal Disease. (HHS 2015) Medicaid low incomes for mothers and children and individuals disabled. HMO's paid by employer of the organization cost of insurance shared by individual and the employer.

How does the insurance work? (Co-payments, Deductibles, Premiums, Capitation, etc.?

Medicare plan has a deductible is paid which covers part of the costs for healthcare expenses for hospital bills and other costs. Small monthly premiums are required for non-hospital coverage. Medicaid usually does not have any expenses that need paid. A cp-payment may be needed for certain medication. HMOs don’t require any deductible (or have a minimal deductible) and only require a small copayment for certain services (Davis, 2020). If you use an out-of-network provider will be very costly and will pay out of pocket full amount.

Give an example of a healthcare service covered under this insurance type? Evaluate how the service is paid for and what is needed for the individual to obtain the service?

Medicare covers certain services such as: Hospitalization, skilled nursing care, facility care, home health services. Medicaid provides impatient and outpatient services, physician services. Laboratory test, X-ray, home health services, prescriptions, Physical therapy and Occupational Therapy. HMO covers Emergency care and Dialysis will be covered. With HMO you pay a co-pay but you have to make sure you are in network or you will pay full amount for any other service not in network.

Is their any political impact on the financial support of these insurance types?

The political issues on the two insurances due to the economy and the Pandemic we are facing at this time. The Medicaid assistance program has had to be relied on due to loss in jobs and the economy being at such a fragile state. Medicare has been relied upon as well as the baby boomers are needing Medicare and also with the Pandemic at this time people being so sick that have contracted Covid-19 and the after affects of this Virus that is causing long term health issues.

References:

Aetna Inc. 2021

Essential of U.S Health care 4th ed, Shi Leiyu, Singh D, 2017, Jones and Bartlett ISBN 971284100556

Medical News Today

U.S. Department of Health and Human Services. (2015, October 2). What is the difference between Medicare and Medicaid? Retrieved from,  https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html