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Senior Health Coverage Goes Beyond Insurance With New Measures

Edward Neeman | Published: June 14, 2018

Seniors healthy food

Medicare Advantage is a type of health insurance given to senior citizens in the United States through private companies approved by Medicare. This advantage was passed through the Balanced Budget Act of 1997 contained in the Part C clause, gave the beneficiaries an option to receive their benefits through capitated health insurance plans.

Initially, the government had a health plan which covered the essential part of the senior citizen’s health maintenance under the “Original Medicare" Parts A & B. Part C was then formed to cover the additional services not listed in the earlier groups. Individuals enrolled in this program get their hospital insurance (Medicare Part A) and Medical insurance (Medicare Part B) from the Medicare Advantage plan and not the original plan.

Types Of Medicare Advantage Plans

  • Private Fee-for-Service Plans (PFFS): Under this plan, the insurance agencies get into the contract with health facilities and create an idea of what part of your care they will cover than the rest you pay on your own. The out of pocket cash amount to be used will vary by the provider offering the plan and the state in which you are seeking the services. The advantage of using this plan is, you do not need any referrals to see the specialists and thus significantly reducing the network limitations through the care providers have to accept the payment terms first.
  • Health Maintenance Organization Plan (HMO): This insurance plan limits the coverage of services to doctors who work for them or have been contracted to give services on their behalf meaning out-of-network care cannot be granted unless in emergency cases. The eligibility criterion for a person to be covered under a particular network is, the person must live or work in the area of coverage, and they have to pay an annual or monthly fee. The advantage of such a program is, the premium charges are often low because the doctors have the patients referred to them.
  • Preferred Provider Organization (PPO): This plan happens to be one of the most popular one under the Medicare Advantage here the subscribers are allowed to visit any healthcare facility that is within the network and are charged at a lower cost. However, you are not limited to the doctors and facilities under your system there is a freedom to use other facilities at an additional cost.
  • Special Needs Plans (SNPs): This plan is a specially designed for particular persons with special needs or specific diseases. The definition of the ‘special’ case is: an institutionalized person, a dual eligible or persons, with severe chronic conditions. The plan has to cover the prescription drugs the patients use, and they require the subscriber to have a specific care coordinator or doctor assigned to them especially if they are not attached to a home.

Apart from the programs above, the United States government under President Trump’s administration is seeking to expand the Medicare Advantage plan supplemental scope on health-related benefits. One of the ways the administration is seeking to do this is:

  • Through driving competition among pharmacies to meet the senior’s needs at a lower cost. The move aimed at reducing the out-of-pocket expenses that the seniors incur a purchase of drugs thus helping them save on the coinsurance costs. The policies that are created are targeted at protecting against overprescribing of drugs and abuse.
  • The government is also keen on establishing support services that increase the health of the citizens through the use of assistive devices and improve the coverage of non-skilled in-home support.
  • The plan is aimed at reducing the paperwork that is involved and cut the regulatory red-tape. The systems to be established are to do the electronic posting of data to ensure transparency and empower the patients in making informed healthcare decisions.
  • A more integrated approach is being taken to compensate for physical impairments and reduce the chances of physical injuries by giving the seniors rides to medical appointments and inspecting their living quarters for any possible hazard.
  • Food-care interventions are also part of the government’s agenda under this program they are looking to supply fresh groceries and home-delivered meals. This idea stemmed from the discovery that many senior citizens who live by themselves cannot go shopping or if they do, cooking can be a big challenge for them.
  • The government promises to provide air conditioners to persons with asthma to help them lead a healthier life. These efforts are an indication that the United States government is focused on improving the lives of the elderly. The policies under Medicare that allow hospitals that operate under the 34B program to buy drugs at a lower cost has especially been helpful in saving an estimated $320 billion personal payments that would be made by the seniors in 2018 alone.