Last week, I discussed the recent history and current importance of Medicaid and it’s expansion during the enactment of the Affordable Care Act. Read that article here. Medicaid is a federal program that provides health insurance to Americans. Mainly, Medicaid works to provide coverage for low-income Americans who cannot afford private insurance. The program is administered by states, who also help the federal government pay for it. Medicaid is not a blanket health insurance, but it links Americans to different coverage plans. In 2010 Medicaid expanded with the Affordable Care Act, listing 3 goals:
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Make health insurance available to more people.
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Expand Medicaid. The ACA expanded Medicaid in 2010 in most states. Missouri opted out of expanding, meaning many are not able to access Medicaid.
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Support innovated medicine to lower the costs of health care.
Health insurance alone is confusing to understand. When we pair the flux of insurance jargon with federal limitations, knowledge access shrinks.
Let’s define some stuff, starting with the general terms and policies of health coverage.
Medicaid is a state-lead, federally-sponsored program meant to connect low-income Americans with limited health care access to coverage.
Medicare is the federal health insurance program for people who are 65 of older, certain younger people with differing abilities, and people with End-Stage Renal Disease. There are Parts A, B and D for different versions for coverage options.
The Marketplace is an online service where Americans shop for different health care plans. It is on HealthCare.Gov.
HealthCare.Gov is the link to access and shop for Medicaid services.
Donut Hole insurance is something that happens in Medicare, not Medicaid. Most plans in Medicare have a gap in what the program will cover for drugs if folks are in Medicare Part D. In 2019, the cost is primarily $3,820. The gap starts after you pay your set amount for drugs when you will have to start paying more for drugs. After you have spent (for most people) $5,100 out of pocket after the donut hole has started, you have reached “catastrophic coverage” in which your plan covers drugs again.
The Medicaid Gap happened after the Affordable Care Act was put into place. So far, 14 states have refused to expand Medicaid coverage to 133% of the Federal Poverty Level or higher. When households are at least 100% of the Federal Poverty Line and under 400% of the Federal Poverty Line. Meaning 2.2 million (including children) do not have health coverage in the US.
The Affordable Care Act is technically the Patent Protection and Affordable Care Act, or PPACA. The ACA was a 2010 resolution to
Obamacare is the Affordable Care Act, not Medicaid.
Mo HealthNet is Missouri’s version of Medicaid.
Billing Providers are the providers where your health coverage plan pays.
The Center for Medicare and Medicaid Services is the federal agency in charge of Medicare and Medicaid.
CHIP is a federal matching fund to states in order to establish medical coverage sources for individuals under age 19 whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage.
WIC is a program to safeguard the well-being and nutrition of low-income women who have been or are pregnant, infants, and children up to age 5 by providing supplemental food, formulas, nutrition education, access to healthcare, and breastfeeding support.
Now, let’s talk about how health insurance impacts you on a daily basis. These are terms you will need to know as you continue being a human person who needs health care:
Deductibles are a portion of a covered loss that is not paid by the insurance plan each year. The deductible is subtracted from the amount the insurer would otherwise be obligated to pay the insured. So let’s say your insurance plan covers the rest after you pay a $500 deductible for mental health services. This means that you pay a portion of that cost for each session until the $500 is gone. After that point, health insurance will cover your therapy.
Co-Pays are fees that vary for different health visits and are cheaper at routine visits. You pay them when you have health insurance. You would pay at the doctor’s office.
Premiums are the amount you pay for health insurance coverage every month, paying the health insurance company, not a seen doctor.
Insurance Claims are claims you make to your insurance company when you have lost a portion of wealth. At best, they will help cover fixing or replacing the damaged thing you own. For example, repairing a house after a fire.
Open Enrollment is a period of time in which people can enroll in a health insurance plan through Medicaid. For 2020, Open Enrollment runs from November 1st to December 15th.
Private Insurance is when a health insurance plan is through the private health insurance industry and not through a federal program or Medicaid. Provided by employers, generally.
Self-Insurance is insuring one’s own self by keeping a fund to cover possible medical expenses instead of having an insurance policy with the federal government or a private insurance plan.
Now, let’s think about how you fit into health coverage. Try to answer these questions:
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Do you have health insurance?
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Do you know who your health insurance provider is?
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The last time you went to a health-based medical appointment, how much did you pay out of pocket?
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Have you ever abstained from seeking medical treatment because of potential costs?
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Are you independent and covering your own health insurance, or are you listed under someone else’s plan? (i.e. your parents)
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If you are under another’s plan, your health coverage will stop at the age of 26. Do you have health coverage plans after that point?
The terms we’ve discussed are dynamic and change person-to-person. If you didn’t need to know any of the terms I defined above, why do you think that is? Which of the questions above were easy to answer, and why do you think that is? It is important to understand health insurance and coverage in terms of personal and sociological experiences of communities and folks of varying identities. The way that you have or do not have health insurance is because of systems of health care that are designed to exclude or include people based on wealth and access.
I turn 26 in four years, meaning I will be off of my family’s plan for the rest of my life. As a full-time student graduating college in half a year, there is much more uncertainty rolling around in my life than just how I will pay for health care. Will I have a full-time job by then that I receive health insurance through? Probably not.
At least we all know a little more about something we knew nothing about.