The Affordable Care Act (ACA) was a law that was enacted that requires all citizens to have insurance or they would be fined a penalty. The ACA is also managed individually by each state although it is federally mandated. The ACA assists with insurance premium payments depending on income to help with affordability to those in need but will require those whose income is too low to choose the Medicaid system. The ACA insurance provides both preventative and medical care to all those insured including children. Dental plans are also offered. (HHS.gov, 2019) People who are unemployed may apply for Medicaid or if they
can afford to may pay privately to extend their insurance from their employer under the Consolidated Omnibus Reconciliation Act (COBRA) for a certain amount of time. (US Dept. of Labor, 2019) German has social security for their unemployed citizens. (How to Germany, 2019) A2a. Discuss coverage for medication in 2 healthcare systems. German state health insurance provides reimbursement coverage for prescription generic drugs. The pharmacy must find the least expensive generic drug. Citizens may have a copay which is determined on a scale and the amount depends on the cost of the medication. In an effort to reduce costs, the public system has demanded discounts from large drug companies. Those that have private insurance are able to have coverage for brand name drugs as long as they have a prescription. Payment is made by the insured upfront and then they submit receipts for reimbursement. (Health Insurance, 2019) Drug coverage in the United States is much more complicated. The federal and state insurance programs, Medicare and Medicaid have drug coverage based on a formulary system. Both Medicare and Medicaid have trended toward managed care systems. There have been several managed care insurance companies that offered an all-inclusive way to manage a recipient’s insurance through Senior Health Maintenance Organization (HMO). Company’s like SCAN, United Health, Humana and many others enroll beneficiaries, manage their Medicare dollars and offer an array of services including drug coverage. In January 1 2006, Medicare did not offer outpatient prescription drug coverage. Patients who were hospitalized had their medication covered under Medicare part A while in the hospital. Outpatient Medicare recipients had to pay out of pocket or they purchased secondary insurance unless they were low income and had a state Medicaid plan. Medicare part D, prescription coverage went into effect on January 1,
2006. (Center for Medicare Advocacy,2019). Through this privatized plan, Medicare contracts with companies that are authorized to sell part D insurance coverage. Medicare does not administer part D directly. These contracts are subsidized by Medicare for a period of 1 year and then are subject to an annual review and renewal. Beneficiaries must purchase a Medicare part D plan from one of these companies and enroll. There is usually a monthly premium and an annual deductible that must be met. There is also a threshold amount that needs to be met at the
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- Fall '18