Introduction
The healthcare system is becoming more complex, with more initiatives and insurance programs being introduced. Medicare, Medicaid, CHIP, and long-term care services are among the most well-known health insurance plans. Each plan has its purpose and components that target specific population groups. Similarly, the insurance models prevalent in the healthcare system exhibit both similarities and differences. Thus, while insurance and insurance plan models aim to improve access to treatment, they differ in terms of the communities and individuals they target, as well as the coverage they offer.
Common Insurance Models
Medicare
The first type of insurance coverage that has to be mentioned is Medicare. The US government’s Medicare health insurance program is available to seniors and anyone under the age of 65 who has a permanent disability. Medicare’s various components help cover specific services.
Part A of Medicare includes coverage for specific medical services at home, acute hospitalizations, care in skilled nursing facilities, and hospice services (Medicare Made Clear, 2021). Outpatient treatment, medical supplies, and preventative services are all covered under Part B (Medicare Made Clear, 2021). Prescription medications, such as numerous highly recommended jabs or immunizations, are covered by Medicare Part D (Medicare Made Clear, 2021).
Medicaid
Another type of health insurance plan is Medicaid, which targets specific individuals and families. Low-income individuals, children, pregnant women, senior citizens, and persons with disabilities have access to healthcare through Medicaid. The primary components of the program include prescription medications, hospitalizations, and other medical services. Therefore, the programs differ in their components.
CHIP
Another type of insurance plan is CHIP, which targets mainly children. As a component of the Balanced Budget Act of 1997, the Children’s Health Insurance Program (CHIP) was established and implemented. Every state must offer comprehensive well-baby and well-child medical treatment, dental coverage, mental health care, and vaccinations, regardless of the type of separate CHIP coverage they choose.
Long-Term Care
Finally, when a person’s capacity to take care of themselves has been diminished by a chronic disease, disability, or age, long-term care services are required. The plan’s components are home health care, personal care, and adult day care, which are offered in the home and community. Besides this, care facilities for older people and nursing homes are examples of institutional environments. Thus, the other two plans target underage children and senior citizens.
Comparison
Regarding various insurance models, there is one specific similarity: the aim to manage healthcare costs. However, there are also differences, primarily in terms of who pays for the insurance, who is eligible for it, and what services are covered (Tikkanen et al., 2020). For example, when discussing the payer of the costs, out-of-pocket expenses are the kinds of expenses that the individual must pay themselves. Similarly, individuals must purchase private insurance. However, government-financed insurance is responsible for paying the citizens’ expenses. Additionally, this is also achieved through employment-based insurance, where the employer covers the employee’s healthcare expenses.
As for eligibility, out-of-pocket and individual private insurance are available to any individual, with the latter being available to anyone who wants to purchase it. In contrast, employment-based insurance is only available to those who are employed. Similarly, government-based insurance can be obtained for specific groups of individuals, such as older people or those with disabilities. Thus, not everybody can be eligible for certain kinds of insurance. Finally, regarding the level of coverage, out-of-pocket expenses are not covered, while other types of insurance coverage offer it, depending on the policy and program.
Conclusion
Hence, although insurance models and insurance plans both aim to increase access to treatment, they differ in terms of the populations they target and the coverage they offer. Long-term care services, Medicare, Medicaid, and CHIP are among the most well-known health insurance programs. The four most common types of insurance are individual private, employment-based private, government-financed, and out-of-pocket insurance. There are several differences, mainly in the insurance’s cost, who qualifies for it, and what treatments are covered.
References
Medicare Made Clear. (2021). Medicare basics: Parts A, B, C & D. YouTube.
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020). United States health care system. The Commonwealth Fund.