Compare Insurance Plans by States
Compare Insurance Plans by State
Description of the Scenario
After servicing in the military for many years, an elderly war veteran decides to spend his remaining years at home with his family. However, because of his age and the nature of his previous job, he is likely to face some of the health problems that may require frequent medication. Nevertheless, he may not be able to afford the high cost of medication because he is no longer on active payroll, which significantly reduced his level of income. Therefore, the elderly man needs a cheaper insurance plan that can cover his medication. As a result, he opted to take Medicaid program, which is more affordable and it is offered in almost all states in the US. But elderly war veteran faces a dilemma choosing the state to move to because they offer slightly different Medicaid cover. He would like to pick Florida, Georgia or Massachusetts. The paper, therefore, compares Medicaid plan in the three states to help the elderly war veteran to choose the best state.
Medicaid was found in 1965, and it is one of the largest publicly financed medical insurance programs (Lee et al., 2010). It is primarily aimed at providing health and long-term care coverage to a given group of low-income individuals in the United States. The program covers pregnant women, children, elderly persons, and disable people who have low income. Every state in the US has the authority and mandate to design and manage their Medicaid programs. Therefore, Medicaid program differs from one state to another. At the same time, a state cannot be forced by the federal government to participate in Medicaid. There are four main types of Medicaid program that include Medicaid to pregnant women that are considered to be low-income, families with children classified under the category of low-income, low-income people with disability, and low-income elderly people. The four types are found in Florida, Georgia, and Texas. However, Florida has Medically Needy Programs that enable individuals who do not meet the minimum Medicaid income requirement to benefit from the program. The main advantage of Medicaid that cut across the three states is that it enables people from low-income families to access cheaper healthcare services (Swartz, 2009). Some people could not access health care services before Medicaid was introduced in 1965. More people can now access medical services, as the Obama care program calls for the expansion of Medicaid to cover more people with low income. Specifically, people under Medicaid can benefit from nursing home services for the elderly, home health services, emergency services for foreigners, and family planning services. Nevertheless, there are also some differences in the same programs in the three states. Medicaid program in Georgia is more restrictive with an income average that is lower than that of the national average. Georgia is also unlikely to expand its Medicaid as per the Obamacare requirements, especially after enacting that makes it broadening the program in 2014. Therefore, the state shows limited commitment to Medicaid. Florida has the largest number of Medicaid beneficiaries in the whole of the US, and it has expanded the program, which indicates that it is committed to cover low-income residents. Texas, on the other hand, is believed to be the state with stringent Medicaid eligibility guideline, especially for the non-disable adults (Lee et al., 2010). It is also the state with the biggest coverage gap in the whole country. Therefore, I would encourage the elderly war veteran to move to Florida.
The Chart below Summarizes the Similarities and Different among the three states
Visual Indication of Florida
(Alibguy, 2015)
Factors that Impacted the State Choice
Eligibility was the primary factor that a person must consider when enrolling for Medicaid in different states because the requirement varies from one state to another. The Medicaid is only eligible to family or individual with low income (de Arellano & Wolfe, 2007). The eligibility requirements for individuals in each category are different. Eligibility rules vary from one state to another despite universal guidelines that govern local options (de Arellano & Wolfe, 2007). Although the federal policy and law require all states to cover people in a particular category, states can choose to include other groups that they feel deserve to benefit from Medicaid program. Therefore, an individual may be eligible in one state by ineligible in another state. However, I paid close attention to the eligibility for the elderly persons. For the elderly person to qualify for Medicaid, he or she must be at least 65 years old. Many states, including Florida, use Medicaid program as a social safety net for the elderly who come from low-income families. States like Florida offer special Medicaid care programs such as Program of All-Inclusive Care for the Elderly, which they use to cover all senior attention and cater for all medical needs of the elderly persons in the society. All veterans who are at least 65 years old and served during wartime are eligible to Medicaid programs in Florida and some of the states. In Florida, the dependents of war veterans are also entitled to the medical cover and may also be eligible for some financial benefits. Also, to be eligible for Medicaid, an elderly person must put all his or her existing assets on care and must have medical expenses that exceed their total income. However, in the case the beneficiary is married, the couple does not need to have exhausted all the available financial resources. Florida allows all the elderly who are the recipient of Supplementary Security Income from the Social Security Administration to be automatically eligible for the Medicaid program. Besides, the old can use their SSI application to register for Medicaid coverage in Florida. Therefore, the eligibility is the primary factor that a person should consider when he or she wants to move from one state to another in the US. The ease of application is another factor that anybody who wants to apply for the Medicaid should consider because the application process differs from one state to another. Medicaid application is tedious because the applicants are forced to go through a complicated list of demographic categories to determine if they qualify in any of the available categories (de Arellano & Wolfe, 2007). Some of the population centered variable that one has to consider before applying for Medicaid coverage include family composition, age, the disability, and marital status. Even though the program is meant for poor people living in the US, not all the poor people are eligible, and not all eligible must have low income or come from low-income families. As a result, the application process is another factor that needs to be considered when choosing because it differs from one state to another. However, despite the tedious process of determining the eligibility of a person, many states have the same procedures for application. The applicant can choose to use Healthcare.org or online platforms that are available for many states. Therefore, it is only tedious to determine the eligibility, but it is easy to carry out an actual application, in particular through online application process (de Arellano & Wolfe, 2007). Those who are not techno savvy can fill the paper forms that are available. Therefore, ease of application is another factor that should be considered when choosing between states a person needs to move. Also, a person should consider the cost of Medicaid, which also differs from one state to another. Medicaid is funded by the federal state governments that pull the resources together to ensure the poor can afford quality health care services. However, one should consider the out-of-pocket cost that individual beneficiary has to incur. There is no specific out-of-pocket cost that a patient has to pay before enjoying Medicaid, but this also varies from one state to another. However, in the case of Florida, a person does not need to pay for his or her share of the cost to benefit from Medicaid coverage. When the Medicaid begin, the Florida pays for the health care services for the rest of the initial month, which makes its program more favorable that the same coverage in states such as Texas and Georgia. Although Florida state cover for the original share of cost in the first month of Medicaid program, health providers in the state find it hard to attend to beneficiaries who have not paid their share of cost (Davis, 2016). Therefore, the recipient may be forced to pay their share of cost promptly to benefit from various health care services that are available. Finally, it is important to consider the services that are offered to the elderly before choosing the state to move. It is better to go to states that provide long-term senior care and PACE because they will enable the elderly to enjoy a wide variety of healthcare services. Florida offer Medicaid services such as PACE and the Statewide Medical Managed Care Long-term Care program, which is aimed at providing both home and community-based health services to Medicaid beneficiaries who are at least 65 years old. SMMC LTC enables the aged Medicaid recipients to access home and in-home health care services (Davis, 2016). The managed care in Florida, therefore, enables healthcare providers to provide quality care services to all Medicaid enrollees in the state. Apart from enrolling for Medicaid program, a person should also consider additional care services that are available in a state, which always vary from one state to another.
Difficulties in Choosing a State
I found it hard to choose a state that offers better Medicaid coverage conditions. Medicaid program is mainly controlled by the federal government, which also sets the eligibility and the requirements for qualification. Therefore, almost all states have the same eligibility requirements that made to choose the best state among the three, Georgia, Florida, and Texas. The three states have almost similar eligibility requirement for the elderly. Consequently, I found it hard to look for the state whose Medicaid terms favor the aged such as the elderly war veteran. Also, I could not find clear information regarding the cost of Medicaid in different states. The share of cost that is paid by enrollees is important in choosing the best state with Medicaid program that favors the elderly. Therefore, I found it difficult to identify the most cost-effective state that offers Medicaid program. As a result, I was forced to rely on other additional care services that are offered along the Medicaid coverage, which made me choose Florida over Georgia and Texas.
Circumstances for Recommending a Different State
An increase in the cost of Medicaid coverage is the primary element that can make me recommend a different state. The main aim of Medicaid coverage is to increase the accessibility of quality healthcare the low-income individual, which means that the target enrollees are not able to afford the high cost of care. Therefore, I would recommend a different state in case Florida increase the share of cost or out-of-pocket costs charged on Medicaid recipients. Cost is a major determinant of the state the elderly war veteran should move to. Florida is also the best among the three states because it offers more care services to the elderly under the Medicaid program. Florida’s long-term care services make it the most favorable state to settle in when a person wants to enjoy the many benefits of Medicaid coverage. Therefore, I can recommend a different state if it reduced the number of long-term care services that are enjoyed by the aged who enroll for the Medicaid program. As a result, increased cost and limited care services are the two most important circumstances that can make me recommend a different state.
References
Alibguy, A. (2015). Florida Redistricting from the Democratic Perspective. Retrieved from http://www.dailykos.com/story/2015/7/17/1403162/-Florida-Redistricting-from-the-Democratic-Perspective
Davis, E. (2016). Florida Medicaid Share of Cost—How Does it Work? Retrieved from https://www.verywell.com/florida-medicaid-share-of-cost-how-does-it-work-1738835
de Arellano, A. B. R., & Wolfe, S. M. (2007). Unsettling scores: a ranking of state Medicaid programs. Public Citizen.
Lee, J. S., Sheer, J. L., Lopez, N., & Rosenbaum, S. (2010). Coverage of obesity treatment: a state-by-state analysis of Medicaid and state insurance laws. Public health reports, 596-604.
Swartz, K. (2009). Health care for the poor: For whom, what care, and whose responsibility?. Changing poverty, changing policies, 26(2), 69-74.
