Question

Apply the knowledge that you have gained about healthcare insurance, and research current articles about the future of health insurance in the United States. Summarize your findings in a two-page paper

Answer 1

#. Knowledge about Health care insurance :

- How did private health insurance in the US begin?

As efforts by hospital and physician providers to deal with the revenue consequences of the Great Depression.

- When did managed care emerge?

The forerunners of managed care plans emerged at the same time as conventional insurance but were subject to serious challenge by physicians, who were concerned about the potential loss of income from the inability to price-discriminate among patients with different demands for care.

- What was the growth of health insurance over the middle of the 20th century primarily spurred by?

The tax-exempt status of employer-sponsored health insurance. Wage and price controls during WWII, the rise of labor unions, and the declaration of health insurance as a proper focus of collective bargaining were other key factors.

- Why were commercial insurers successful in the insurance market?

Because they introduced experience rating, which allowed them to offer lower-priced coverage to groups with lower expected claims experience. The rest of the industry followed suit.

- What expanded insurance coverage to older Americans?

The enactment of Medicare in 1965. The current Medicare program reflects the nature of private health insurance in the 1960s. The allowable cost reimbursement system, largely borrowed from the provider-designed Blue Cross and Blue Shield plans, entrenched cost-based reimbursement for 20 years.

- What did the passage of the Employee Retirement Income Security Act (ERISA) in 1974 lead to?

The growth of self-insured employer health plans and all but ensured competition int he risk-bearing segment of the conventional insurance market.

- What was the growth of managed care in the 1980s and 1990s a result of?

The introduction of selective contracting as a response to growing healthcare costs. Selective contracting introduced price competition into healthcare markets.

- When were Medicaid and Medicare both dramatically expanded?

In the 1980s-2000s. Medicaid and the Children's Health Insurance Programs provided greater eligibility for children under age 19. Medicare was expanded to include prescription drug coverage.

- What happened in the 1990s and 2000s?

The 1990s and the 2000s saw consolidation among healthcare providers and a backlash against the utilization management of managed care plans. Both actions undercut the ability of managed care plans to selectively contract.

- When did consumer-driven health plans offering a high-deductible insurance plan and a tax-sheltered health spending account emerge?

In the 2000s, and it it grew to enroll about 1/7 of the insured workforce.

- Medicare

the federal health insurance program for people who are 65 or over. Certain younger people whit disabilities and people with End-Stage Renal Disease may qualify

- Medicaid

is a jointly funded, Federal-Stae health insurance program for low-income and people in need. It coveres children, the aged, blind and/or disabled and other people who are eligible to receive federally assisted income maintenance

- Medicare Part A

-Hospital Insurance

-Provides coverage with no premium costs, for inpatient hospitalt services, skilled nursing facilities, home health services and hospice care to all persons eligible

- Medicare Part B, Supplementary Medical Insurance (SMI)

-Asissits in paying for the cost of physician services, outpatient hospital services, medical equipment and supploes and some of the other health services and supplies

-Finances through: (1) premium payment, which is usually deducted from the monthly Social Sevurity benefit checks, and (2) through contributions from general revenue of the U.S treasury

- Medicare Part C, Medicare Advantage Program

-Coordinated care plans, which include health maintenance organizations (HMO), provider-sponsered organizations (PSO) and preferred provider organizations (PPO)

-Other certified public or private coordinated care plans and entities that meet the approved required standards

- Mangaged Care Plans

The Medical beneficiary selects a specific HMO or other approval plan within a service area for comprehensive healthcare services

- Beneficiary Payment Liabilites

beneficiaries are responsible for charges not covered by the Medicare program and for various cost-sharing aspects of both HI and SMI

- These liabilties may be paid by..

-The Medicare Beneficiary

-A third party such as a Private Medigap insurance purchased by the Medicare Beneficiary

-Medicaid, if the person is eligible

- Medigap

is used to mean private health insurance that, within limits, pays most of the healthcare service charges not covered by parts A and B of Medicare

- Medicaid regulations and policies, each state

-Establishes it's own eligibility standards

-Determines the type, amount, duration and scope of services

-Sets the rate of payment for services

-Administeres it's own program

Current articles about future of health insurance :-

- The future of Affordable care act and insurance coverage by NCBI

- Three years in changing plan features in US health insurance marketplace

- The future of health insurance by Delloite .