MSN 601 - DB week 5
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Northern Kentucky University *
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Course
601
Subject
Health Science
Date
Jan 9, 2024
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Prepare the following information as if you were going to provide education in your community at a health fair. The information can be in bullet point format. Under each of the items (A-E), outline bullet points with the information that are key points to discuss when providing education on the topics. APA format format for intext citations and reference list should be included.
1.
Identify and summarize the three categories of state Marketplace/Exchanges.
There are three different types of state marketplaces. State-based Marketplace (SBM), State-
based Marketplace-Federal Platform (SBM-FP), and Federally-facilitated Marketplace (FFM). SBMs are run by the state and the state controls the functions of the market. The state is also responsible for maintaining and establishing websites used for enrollment of plans (Kaiser Family Foundation [KFF], 2021). SBM-FPs are basically SBMs with the exception that the state utilizes the federal government's website, Healthcare.gov, to determine eligibility as well as for enrollment purposes (KFF, 2021). FFMs the federal government, specifically the department of Health and Human Services (HHS) is responsible for for the marketplace, including enrollment through Healthcare.gov (KFF, 2021).
1.
Discuss the five metal categories of plans that individuals can access through Marketplace including services provided by each plan.
There appears to four metal plans associated with the Affordable Care Act: bronze, sliver, gold, and platinum. The bronze level offers the lowest premiums of all the plans, in which the consumer pays 40% out of pocket (HealthCare.gov, n.d.). Deductibles for this plan can be very expensive and the consumer would be responsible for most routine care expenses (HealthCare.gov, n.d.). The silver level plan is considered to have a moderately priced monthly premium, have lower deductibles than the bronze plan, the consumer covers 30% of the total costs, and more routine care is covered (HealthCare.gov, n.d.). The gold plan is associated with high monthly premiums, and relatively low cost of 20% when care is needed, low deductibles, and is probably better suited for someone who uses health services a lot (HealthCare.gov, n.d.). Platinum is has the highest monthly premiums, but also the lowest costs when you get care--10% by consumer; low deductibles; and is good for someone who uses health services a lot (HealthCare.gov, n.d.).
1.
Outline the Health Insurance Marketplace® efficiency, effectiveness, cost, and access to diverse and vulnerable populations.
Efficiency: The implementation of the Health Insurance Marketplace had a turbulent start including political opposition and provision that were never implemented (Mason et al., 2021). Technological difficulties due to lack of proper infrastructure plagued the role-out leading to expanded timeline that would take several years for full implementation (Mason et al., 2021). Then in 2016, the shift in political power resulted in weakening of the ACA (Mason et al., 2021). Effectiveness: When comparing states that have chosen to expand Medicaid and those that did not expand Medicaid, it is possible to compare and contrast effectiveness that the Marketplace has had in terms of quality. Since 2019, there have been larger gains for individuals suffering from newly diagnosed cancer and diabetes in states that have expanded Medicaid (Mason et al., 2021). Furthermore, the possession of healthcare insurance is associated with patients seeking out care earlier in disease process commonly requiring surgery (Mason et al., 2021). In contrast,
infant mortality rates increased between 2010 and 2016 in states expanding Medicaid when compared to the national average (Mason et al., 2021).
Cost: Following the expansion of Medicaid in 2014, there has been an increase in the cost healthcare expenditures. In 2014, the cost expenditure increased by 5.3% and by 5.8% in 2015 (Mason et al., 2021). This was associated with an increase in the number of insured Americans, growing from 86% to 90.9% (Mason et al., 2021). Unfortunately, lower-income adults are affected the most by this, from 2016 to 2018 the rate for uninsured Americans increase from 20.9% t o 25.7% (Mason et al., 2021).
Access: Initially, under the ACA, the Marketplace was able to reduce the number of uninsured, nonelderly adults from 18.2% in 2010 to 10.3% by the end of 2016 (Mason et al., 2021). However, due to lack of government intervention, approximately four million individuals have lost coverage since 2014 (Mason et al., 2021). However, several studies argue that the ACA reduced disparities for lower-income populations. Griffith et al. (2017) concluded that when comparing states that chose to expand Medicaid to those that opted not to expand, the rate of uninsured healthcare consumer fell from 31% to 17% percent in states that expanded Medicare while states opting out of expansion fell from 36% to 28%. In this case the direction comparison of the rates of the uninsured is evidence that the Marketplace increases access to healthcare services for those with socioeconomic disparities (Griffith et al., 2021). 1.
Discuss the benefits and consequences of the ACA Medicaid expansion.
The expansion of medicaid under the ACA shows a significant reduction in the number of people, especially those underserved communities or those facing healthcare disparities (Antonisse et al., 2018). The expansion all lead to an increase dental coverage, resulting in fewer people being uninsured for dental care as well a a decrease in the amount of uninsured child (Antonisse et al., 2018). One of the consequences of medicaid expansion is the increase in financial burden that is associated with high deductible plans. While high deductible plans have a much lower impact on upper and middle-class families, low-income families experience a
greater financial burden associated with higher deductibles (Abdus et al., 2016). Low-income families report a financial burden of 29.1% or greater of their after tax income on healthcare expenses assoicated with high deductible plans. Furthermore, low-income families opting for low-deductibles still spent an average of 20.6% of their after-tax income on healthcare plan related expenses such as higher premium rates (Abdus et al., 2016). So while it's important to notes that rates of uninsured healthcare consumers has declined since expansion, it is also associated with an increase in financial burden for low-income families.
1.
Describe the basic components and requirements of the Medicare Program, including the differences between Medicare Part A, Part B, Part C, and Part D
Medicare can be divided into four different parts. Medicare Part A is the designation for inpatient covered services. These can include inpatient hospital services, skilled nursing facilities, home health care services, and hospice care. There are some limitations to Medicare Part A and Medicare and the patient will likely need to financially cover a portion of the costs they incur (Medicare Interactive, n.d.). Medicare Part B is typically associated with outpatient covered services and other types of medical coverage. These can include medically necessary services associated with one’s provider, durable medical equipment or medical equipment that intended
for repeated and extent use (Medicare Interactive, n.d.). Certain types of home health services such as those intend for patients that are homebound and required skilled nursing or therapy services (Medicare Interactive, n.d.). Part B is also used for ambulance services or transportation services that are medically necessary (Medicare Interactive, n.d.). Additionally, Part B also covers preventative care services, therapy services (occupational, speech, etc.), and mental health services (Medicare Interactive, n.d.). Finally, Part B also provides some coverage for X-rays and lab tests, certain types of specialized medications, and chiropractic care that is deemed medically necessary (Medicare Interactive, n.d.).
Medicare Part C is also known as either Medicare Advantage or Medicare private health plan. These plans pay a fixed amount of healthcare costs per person. Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-For Service (PFFS), Special Needs Plans (SNPs), Provider Sponsored Organizations (PSOs), and Medical Savings Accounts (MSAs) are all associated with with Medicare Part C (Medicare Interactive, n.d.). Many of these services have require a monthly premium, may have cost-sharing expenses associated with services such as dialysis or chemotherapy, but also place a limit on the patient’s out-of-pocket expense (Medicare Interactive, n.d.). Additionally, other such as dental and vison may be part of an individual’s coverage and may require an individual seek care in a particular network (Medicare Interactive, n.d.).
Medicare Part D covers prescription medications. Covered medications can be found in Medicare Part D formulary, unfortunately medication not found in the formulary will either require an exception request or will need to covered via out-of-pocket (Medicare Interactive, n.d.). Certain medications, such as weight loss medication or over-the-counter medicines, are not covered by Part D (Medicare Interactive, n.d.). References
Abdus, S., Selden, T. M., & Keenan, P. (2016). The financial burdens of high-deductible plans. Health Affairs, 35(12), 2297-2301. https://doi.org/10.1377/hlthaff.2016.0842
Antonisse, L., Garfield, R., Rudowitz, R., & Artiga, S. (2018). The effects of Medicaid expansion under the ACA: updated findings from a literature review. Published March.
Griffith, K., Evans, L., & Bor, J. (2017). The Affordable Care Act reduced socioeconomic disparities in health care access.
Health Affairs
,
36
(8), 1503-1510. https://doi.org/10.1377/
hlthaff.2017.0083
HealthCare.gov. (n.d.). How to pick a health insurance plan. The health plan categories: Bronze, silver, gold & platinum. https://www.healthcare.gov/choose-a-plan/plans-categories/
Kaiser Family Foundation. (2021). State Health Insurance Marketplace Types. https://
www.kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/?
currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%
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Mason, D. J., Dickson, E.L., Perez, G.A., & McLemore, M.R. (2021).
Policy & politics in nursing and health care
(8th ed.). Elsevier.
Medicare Interactive, (n.d). The Parts of Medicare (A,B,C,D,).
https://
www.medicareinteractive.org/get-answers/medicare-basics/medicare-coverage-overview/
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medicare#:~:text=Part%20A%20provides%20inpatient%2Fhospital,D%20provides%20prescript
ion%20drug%20coverage