Walden University Private and Public Insurance in United States Responses

I need an explanation for this Psychology question to help me study.

Read a selection of your colleagues’ postings.

Respond to at least two colleagues who are from different U.S. states in one or more of the following ways:

Suggest additional differences between Medicare and Medicaid that your colleague did not mention.

Critique your colleague’s post and expand on it by suggesting additional insight as to how one’s insurance may define access to health care.

Use Reference:

DB 1

Karlee—

The biggest difference in public and private insurance is the care that you are going to get. If you look at public health care you are looking at CHIP’s, Medicaid, and Medicare these are services for children of low-income families, the elderly population, and then those who are poor. “Although the U.S. healthcare system represents one of the largest economies in the world in its own right, much of health policy debate is focused on strategies to lower consumer, business, and government spending on health care.” I take this is the government is looking for ways to cut benefits to people so that they can pay less and less in regard to public healthcare” (Gehlert & Browne, 2019). Then when you look at private insurance like Blue Cross Blue Shield and HMO plans, these are plans that are mostly provided by employers to employees. These are for like the middle- and upper-class population where they can afford to make monthly payments on insurance that way, they have it if they ever need it. They can all go to any provider that takes their specific insurance.

Medicare is for individuals that are sixty-five years or older or those under sixty-five that have disabilities. Medicare has four parts, A, B, C, and D, “part A covers inpatient hospital, skilled nursing facility, hospice, and some home healthcare services” (Gehlert & Browne, 2019) part A is given to you when you hit sixty-five with social security benefits. Next, we have part B covers outpatient services, as well as lab testing x-rays and physical and occupational therapy. Part B is optional you can become eligible for it when you become eligible for part A. Part C I also optional and said to reduce the costs of the original Medicare the only downside it could give you equal or lower care than you would receive on the original Medicare but at a cheaper price. Lastly, we have part D which is for prescription drugs, it is also optional it gives reduced or free charges to prescription drugs.

“Medicaid is a means-tested health public insurance entitlement program financed by the federal government and the states. The program is a substantial player in the overall U.S. healthcare system, covering one out of five Americans” (Gehlert & Browne, 2019) Medicaid is guaranteed to pregnant women and children under the age of six if they have an income under the federal poverty level, as well as individuals and families that are also below the poverty line. Because it is publicly funded it is free for those who are on it, however, the occasionally may need to pay a co-pay for services. The issue with this is if you do not hit the poverty level the government is looking for then you do not get the coverage that could cause issues with the individual’s health and financial stability.

In the state of Texas, we have the Healthy Texas Women with this program “More women can now get free or affordable healthcare services statewide. The Healthy Texas Women program offers comprehensive healthcare, including birth control, pregnancy tests, and counseling, and health screenings and treatment for hypertension, diabetes, and cholesterol. The Family Planning Program will now offer more services, including limited prenatal care.” (Healthy Texas Women 2015)

Gehlert, S., & Browne, T. A. (2019). Handbook of health social work. Hoboken, NJ: John Wiley & Sons.

Healthy Texas Women. (2015). Retrieved October 07, 2020, from https://www.healthytexaswomen.org/about

DB 2

Michael—

Post an explanation of the differences between the public and private health insurances as well as the difference in access to care based on one’s insurance.

The difference between public health care and private health care is who is providing health care coverage (Gehlert & Browne, 2019). Private health care insurance can be supplied by the individual’s employer or can be purchased from individual insurance companies, both include the individual or employer/individual paying a premium for coverage (Gehlert & Browne, 2019). Public health care insurance is provided by the government and consists of three main programs: Medicaid, Medicare, and the Children’s Health insurance program (CHIP) (Gehlert & Browne, 2019). To receive one of three government programs, and the individual must meet the strict age and financial qualifications.

Explain the differences between Medicare and Medicaid in terms of eligibility, cost, benefits, services provided, and limitations in services.

Medicare is primarily for individuals 65 or older, under the age of 65 with certain disabilities and for individuals of all ages with end-of-stage renal disease (Centers for Medicare and Medicaid Services, n.d.). Medicare recipients pay a monthly premium like regular insurance with deductibles and co-pays and are broken down into three parts:

Part A: Helps pay for hospital coverage, hospice, and some health care. In most cases, individuals do not need to pay a premium for this coverage because they or their spouse covered it by paying payroll taxes (Centers for Medicare and Medicaid Services, n.d.). Conditions must be met for this coverage.

Part B: Covers medical care that part A does not, along with doctor visits and outpatient care (Centers for Medicare and Medicaid Services, n.d.).

Part D: This is a prescription coverage plan that is available to all who have Medicare and might require a premium to be paid (Centers for Medicare and Medicaid Services, n.d.).

Medicaid is a coverage program that is financed by both the federal and the state and is regulated differently by each state (Gehlert & Browne, 2019). Medicaid is for Low-income families, qualified pregnant women and children and individuals receiving Supplemental Security Income (SSI), each state has additional options for coverage (Centers for Medicare and Medicaid Services, n.d).

Finally, describe special programs that your state’s Medicaid program offers to increase access to care for vulnerable populations, such as pregnant women, children, single mothers, or immigrants.

The state I live in is Colorado. The programs that are available if you already qualify for Medicaid are:

Food assistance program (SNAP), commonly known as Food stamps

Cash and Employment Assistance programs:

TANF/Colorado Works: This program that provides cash assistance to qualifying families of at least one parent and one child while they are preparing for, looking for, and/or maintaining employment.

Aid to Needy Disabled: Cash assistance for individuals under age 60, living with a disability lasting six months or longer that prevents them from working.

Aid to the Blind: Provides financial assistance to low-income people of any age who meet the social security definition of blindness.

Old age Pension (AOP): Provides assistance and health care benefits for low-income individuals age 60 and over.

Medicare Savings Programs (MSP): Programs that may pay for your Medicare A & B premiums and/or co-pays and deductibles.

Burial Assistance: Provides financial assistance to help pay for funeral, burial, and/or cremation costs for individuals whose estates are insufficient.

Child Care Assistance Program (CCAP): provides access to reduced cost childcare at licensed childcare facilities or qualified (unlicensed) providers.

Low Energy Assistance Program (LEAP): provides assistance in paying utilities.

The Above information was provided by:

Public Benefits (Human Services). (2020). Retrieved October 07, 2020, from https://www.larimer.org/humanservices/public-benef…

Centers for Medicare and Medicaid Services. (n.d.) Retrieved from http://www.cms.gov/

Gehlert, S., & Browne, T. (Eds.). (2019). Health policy and social work. In Handbook of health social work (3rd., pp.120-138). Wiley. https://doi.org/10.1002/9781119420743

Public Benefits (Human Services). (2020). Retrieved October 07, 2020, from https://www.larimer.org/humanservices/public-benef…