M. Wise HI215 Unit 4 Assignment
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Purdue Global University *
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Course
215
Subject
Health Science
Date
Dec 6, 2023
Type
docx
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3
Uploaded by ChiefTreeQuetzal32
Private Insurance
The Kaiser Family Foundation (KFF) website includes several indicators for Health Insurance and
Managed Care. Insurance Market Competitiveness is the first indicator that is listed. This area goes over
the competition that exists within individual, small group, and large group insurance markets. Health
Insurance Broker Compensation and Rate Reviews are two other indicators that are listed on the KFF
website. The Affordable Care Act put into place a process that rate increases of 15% or more by
individual or small group marker insurers be reviewed by independent experts to justify the need for the
increase. Brokers fees are calculated by dividing the sum of all agents, brokers fee, commissions, direct
sales, and benefits in a state by the total number of members that are enrolled. This is a per member per
month process. This just gives a bit more insight into how health insurance works based on certain
regulations by the state and the ACA.
Private insurance covers medical, hospital, and preventive care. While plans can vary in terms of
coverage, they help to pay for a range of medical services. These coverage levels are provided at
different costs, which can make it easier for a wider range of people to have the kind of healthcare
coverage that they need. Private coverage is a great thing because more people can access insurance
plans, but this has still not managed to give health insurance to the whole population of the US.
Managed Medicaid
Medicaid HMO penetration is used to test for any participation in Medicaid and to what degree
physicians accept new Medicaid patients. There has been an increase in the penetration of HMOs when
it comes to the acceptance of new Medicaid patients, especially in terms of office-based physicians. The
effects of Medicaid HMO penetration in correlation with physician participation vary by plan and by
state. The different percentages of HMO penetration by state have to do with the state’s ability to attract
and keep commercial plans, which increases a physician likelihood of accepting more Medicaid patients.
Medicaid managed care enrollment has increased due to shifts in financial risk and expansion of patient
access to care.
Government provided health insurance plans provide low-income individuals with coverage for
their health needs. This allows more people access to preventative care. This means that these people
can seek help before they become ill. Affordable healthcare is needed to allow individuals to seek
treatment when needed, but this also means that that care must be accessible to them in terms of
location and cost. Different forms of healthcare helps to ensure most people are able to seek care, but it
still has not provided a guarantee for every individual to be able to seek treatment when needed.
References
Adams, E. K., & Herring, B. (2008). Medicaid HMO Penetration and Its Mix: Did Increased Penetration
Affect Physician Participation in Urban Markets?
Health Services Research
,
43
(1p2), 363–383.
https://doi.org/10.1111/j.1475-6773.2007.00763.x
Health Insurance & Managed Care
. (n.d.). KFF.
https://www.kff.org/state-category/health-insurance
managed-care/?state
Medicaid Managed Care Market Tracker – The Henry J. Kaiser Family Foundation
. (2020). The Henry J.
Kaiser Family Foundation.
https://www.kff.org/state-category/medicaid-chip/medicaid
managed-care-market-tracker/
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