Sociology Research Paper on Long-Term Health Care Plan

Long-Term Health Care Plan

Q1. Medicare and how one qualifies to enjoy the insurance

In the US, Medicare is one of the national insurance programs that the federal government has been administering since 1966 (Medicare program, 2009). The program pays for various health care services that its members have incurred. The program is managed by the (CMS) Centers for Medicare & Medicaid Services, which is a division of the United States (US) department of health and human services. Like the social security program, Medicare, is an entitlement program, whereby the members wishing to be enjoined to the program work and pays taxes for a given number of minimum years. One may also benefit from the service even though he/she did not work long enough, but he/she would be required to pay more into the program.

Medicare health insurance program is an entitlement to those US citizens who have attained the age of 65 and above. People who are under the age of 65 but have certain disabilities as well as any person irrespective of age but have ESRD- End-Stage Renal Disease or permanent kidney failure that requires a transplant or dialysis are considered (Petrie, 1992).

Medicare has four distinct parts, whereby part A and B are referred to as the original Medicare, part C (Medicare Advantage), is a private health insurance while part D is used to cover prescription drugs (Aschkenasy, 2006). The hospital insurance generally covers the inpatient care, skilled nursing facility care, hospice care, and home health care (Simmers, 2008). One does not necessarily have to pay the monthly premium to enjoy this service, as it is premium free.

The medical insurance covers the services from the health care providers and the doctors, outpatient, and home health care as well as durable medical equipment and certain preventive services (Simmers, 2008). Medicare advantage entails the benefits of the original Medicare, the medical insurance, and the prescription drugs. It is operated by certain approved private insurance companies and may include extra benefits for extra costs. Part D that covers drug prescription is run by certain approved Medicare private insurance companies, and covers the cost of prescription drugs (Aschkenasy, 2006).

Q2. What other insurances or plans do you need for a Long-Term Care plan?

            Long-term care insurance (LTCI) is mostly offered by the private insurance companies, and may cover services including home care, adult day care, or assisted living. It also includes Alzheimer’s facilities, hospice care, adult day care, and nursing home care among others services. Some of the options for LTCI include the voluntary plans, the carve-outs, and the blended plans (Batsell, 2010). These options pose challenges for underwriting in terms of participation, persistency, and compensation.

The voluntary plan is usually endorsed by the employer, giving permission to the insurance company to offer the service to the employees. Usually, the employee pays premiums that cover themselves and their families. The majority of insurance companies do not prefer this service. To the employees or contributors, the participation rates are usually lower than others. The carve-outs on the other hand have premiums paid in full or in part by the employer (Batsell, 2010). The employer is usually selective and decides on whom to cover with the service. The spouses of the employee may be covered by the policy. Its participation rate is usually very high. The blended plan is another type of LTCI and includes the carve-out plans and the voluntary plans.

References

Aschkenasy, J. (2006, Feb 01). Drug deals: How to help your clients make sense of Medicare part D. Financial Planning, 1-81. Retrieved from http://search.proquest.com/docview/210959103?accountid=1611

Batsell, M. (2010). The 3 types of worksite long term care insurance plans — and why they make sense for group clients. Agent’s Sales Journal. Retrieved from http://search.proquest.com/docview/822958829?accountid=1611

Medicare program; recognition of NAIC model standards for regulation of Medicare supplemental insurance. (2009). Lanham: Federal Information & News Dispatch, Inc. Retrieved from http://search.proquest.com/docview/190248833?accountid=161

Petrie, J. T. (1992). Chapter 1: Overview of the Medicare program. Health Care Financing Review, 1. Retrieved from http://search.proquest.com/docview/196988181?accountid=1611

Simmers, L., Simmers-Nartker, K., & Simmers-Kobelak, S. (2009). Diversified health occupations. Clifton Park, NY: Delmar Cengage Learning.