The United States and the Health Care - Essay Example

"The United States and the Health Care" is an excellent example of a paper on the health system. 
Name of plan 

The insurance cover that I use is by Medicaid. 

Source  

It is part of the Amerigroup Community Care Medicaid Advantage Plan which is a program for people who have both Medicare and Medicaid. It is a public healthcare coverage provided by the federal government for families with relatively low incomes. 

Your out-of-pocket costs: co-payments and deductibles 

Medicare does not cover certain deductibles and copayments. On joining the Amerigroup Medicaid Advantage Plan, deductibles and copayments are covered except for pharmacy items. Monthly premiums for benefits are also covered and one does not have to pay for them. Medicaid Advantage plan also covers extra services not covered by Medicare (Ketler, 2008). 

Percentage of coverage  

Medicare and Medicare Advantage plans cover 100% of medical costs excluding pharmacy costs. 

Major limitations  

Long term conditions not covered by Medicare include serious mental illness, long-term therapies, Methadone treatment, Personal care services, Comprehensive Medicaid case management, directly observed for TB therapy, adult day treatment for persons with HIV/AIDS, HIV COBRA case management, adult day healthcare, personal emergency response services, and out-of-network family planning services. The other limitation is the prior authorization required before obtaining some services and takes between 1-3 days, not more than 14 days. It can be done by oneself or a trusted individual. A service that requires prior authorization includes non-emergency transportation (Cackley, 2010). 

Exclusions 

As a result of having Medicaid, you get some extra services from providers who are in the Amerigroup Medicaid Advantage network the plan which must be medically necessary and require a referral from your provider. Private duty nursing services are provided through an approved certified home health agency, home care agency, or a private practitioner. These services may be given in a facility or the member’s home (Russell, J. M., and Atlantic Publishing Co. 2008). Ambulance, inpatient surgical dental services, and visual aids including eyeglasses, medically necessary contact lenses are covered, as well as repair or replacement of parts, examinations for diagnosis, and treatment for visual defects and/or eye disease. 

Discuss the options a non-military person would have if they were to lose their coverage. 

If a non-military loses coverage due to loss of a job, divorce, death, or when a dependent child grows older and is no longer a dependent, several options are available to maintain coverage. Federal laws like COBRA, HIPAA, and TAARA are options one can look in to (U.S. Department of Labor, 2007). One may choose to use a spouse’s or partner’s coverage which can be applied for within 30 days. Public programs like Medicaid and CHIP may be an option if one has low income. One may also get coverage through his or her spouse, domestic partner, or parent’s employer. 

The ex-military person may also be eligible for the Health Coverage Tax Credit that comes with Trade Adjustment Assistance or Pension Benefit Guaranty Corporation that pays benefits for certain pension payments. Some of your family members (children or spouses) may be eligible for coverage under Medicaid, the Children’s Health Insurance Program (CHIP), or any other state or local program such as mini-COBRA, conversion policies. This makes COBRA premiums cheaper for an individual when the rest of the family has different coverage (U.S. Department of Labor, 2007). If there is no better option, one may opt to buy insurance in the individual market.