Health Exchange Paper
How it works
The Kaiser Family Foundation is a non-profit organization that helps to provide information on important health policy issues involving the United States’ role in health insurance. When first looking at the website, it seems like there’s a lot of information to begin with and you don’t know where to start. After looking around the website, there’s a tab that gives you options to click on giving you a lot of information on different topics including Disparities Policy, Global Health Policy, Health Cost, Health Reform, HIV/AIDS, Medicaid, Medicare, Private Insurance, Uninsured, and Women’s Health Policy. This website can be a little tricky to navigate if you don’t find yourself well educated enough to know where to go and what to look for. Although, I can’t deny that the website does provide an abundance of information that everyone can benefit from especially if you do not find yourself knowing about these topics. The main focus will be put on the 3 types of insurance which would be Medicaid, Medicare, and Private insurance.
Medicaid is a type of public insurance that is available to lower income people of the US. Before the Affordable Care Act, Medicaid was only limited to select people such as the elderly, people with disabilities, pregnant women and children but with the Medicaid expansion it opened it up to those who met the certain requirements (KFF, 2020). Medicaid can help many peoples lives who see themselves having health issues, it helps cover the very costly long-term care some may need for millions of seniors and those with disabilities who need care within the community or even in nursing homes. There were millions of people who were excluded from health insurance and these people as a result avoided seeking medical care due to the hefty bill they would get back due to them not having insurance. Looking at the pros of Medicaid which would be that this public insurance allows millions of Americans have the ability to seek medical care when they need it without the fear of having to pay for their medications, visits or being turned away due to them being uninsured.
How it works
On the other hand, the con of Medicaid would be the unfairness seen across the US with the fact that there are 14 states that have made the decision to not expand with the ACA leaving quite a few million of people uninsured and also the big issue with this insurance is that sometimes Medicaid does not provide assistance to those who are below the poverty line for other coverage options. This leaves some people in a “coverage gap” meaning that they fall below the poverty line but they are above the Medicare eligibility (Garfield, Orgera, 2020). Medicare is a type of federal insurance that is available to individuals that are 65 years old or older regardless of their income, medical history, or health status and it was also expanded to include certain people under the age of 65 with long-term disabilities. This program helps with paying for many health-care services including hospital stays, doctor visits, prescription drugs, preventative services, home health care, and hospice care (KFF, 2019).
There are different parts of Medicare such as Part A, B, C and D covering different areas for the patient. Part A covers hospital stays, skilled nursing facility stays, certain home health care, and hospice care. People with Part A can be charged a deductible of $1,364 and coinsurance is required for extended hospitalizations and SNF. Part B covers doctor visits, outpatient services, preventive services, and some health home visits. Many people can be subjected to paying a deductible of $185 and require coinsurance of 20%. The patient will not need a coinsurance or be subjected to a deductible if they are going for a wellness visit or preventative services (KFF, 2019). The pros of this program would be that the elderly and certain young adults have an insurance program available to them for when certain services are needed for them. The cons would be the deductibles the patient would have to pay, these elderly people or those with disabilities don’t have jobs which would give them no means to be able to pay for the deductible which would result in these individuals to rather not seek out care. Another con would be that traditional Medicare does not help the elderly or young adults help pay for their important services which would include dental services, long-term services, hearing aids, eyeglasses (KFF, 2019).
Lastly, private insurance is a type of insurance that is not funded by the government. It is a form of health care coverage that is given by a private health insurer, people that are covered under this is non-elderly with employer-sponsored coverage or individually purchased health insurance. With private insurance most of the premium is paid for by their employers or dependents, ACA requires that employers provide their full-time employees and their dependents health coverage that can meet the minimal standards (Claxton, Cox, Levit, et al. 2019). The pro with this type of insurance is that the individual does have more coverage than someone who would be on Medicare or Medicaid so it may result in them being able to seek preventative services, adhere to their medication regimen, and attend their doctor’s appointments. The con with this insurance is that it is not that easily accessible to low income people, the cost of the insurance may be too high or they may not have the option to get this type of insurance. There’s also another set of levels of insurance that can be taken into consideration when choosing plans such as bronze, silver, and gold. Bronze plans are the lowest-costing plan out of the three, with this the individual has access to some primary care, no-cost preventive services, and also financial protection. The individual pays for the majority of their health insurance through deductibles around the prices of $6,506 annually and also any out of pocket expenses that may be needed (KFF, 2019). On the other hand, you have the platinum level which is the most expensive option with the individual paying a high premium but they also pay a little to no deductible.
In conclusion, the Kaiser website provides a lot of useful information about health insurance and the ins and outs. The website can be a little overwhelming with the abundance of information they give so it can be hard to comb through the information of what is needed. This information can be very useful in the future when I need to go back and reference to health insurance and its policies.
- Altman, D. (2019, September). The Henry J. Kaiser Family Foundation. Retrieved from https://www.kff.org/