Discussion of Medicare Programm

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Three types of state Marketplace implemented in the ACA are State-based Marketplace (SBM), Stated-based Marketplace-Federal Platform (SBM-FP), Federally-facilitated Marketplace (FFM). According to KFF (2020), State-based Marketplace (SBM) performs all marketplace functions for the individual market. Consumers could obtain and apply for coverage through marketplace websites depending on their states. KFF (2020) states that State-based Marketplace-Federal Platform (SBM-FP) requires a State-based Marketplace and performs all marketplace functions for the individual market, but Healthcare.gov should confirm eligibility of the procedure. On the other hand, Federally-facilitated Marketplace performed all marketplace functions and obtained through Healthcare.gov.

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There are four metal-level tiers and one additional plan offered by insurance companies: Platinum, Gold, Silver, Bronze, and Catastrophic plan. The metal levels indicate the cost for healthcare distributed between insurance companies (Healthsherpa, 2020). According to Healthspherpa (2020), due to the Affordable Care Act, all Marketplace plans must include the following services: ambulatory patient services, emergency services, hospitalization, pregnancy, newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services.

Starting from Bronze plans, it cover 60 percent of healthcare costs, leaving 40 percent on the consumer. This type had the lowest monthly premiums compared to other programs. Moreover, the Bronze plan has the highest annual deductibles (Healthsherpa, 2020). Generally, the Bronze plan is the most cost-effective option of insurance.

The silver plan covers 70 percent and leaves 30 percent of healthcare costs on the consumer. Healthsherpa (2020) mentions that this plan has moderate cost needed for healthcare and low deductibility compared to Bronze. On the other hand, the Gold plan pays for 80 percent, while consumers need to cover 20 percent of covered healthcare costs. This type has very low deductibles and the cost of actual access to healthcare (Healthsherpa, 2020).

Talking about the Platinum plan, it covers 90 percent of healthcare costs and leaves 10 percent to the consumer. According to Healthsherpa (2020), this type has the lowest deductibles and cost for actual access to healthcare. The catastrophic plan differs from metal-level tiers, as it has very low monthly premiums and a very high annual deductible (Healthsherpa, 2020). This category could cover some services at no cost and is available for people only under 30.

As nurses are the main driving force in this system, they obtain a privileged position in the age of the Affordable Care Act. Nurse Journal (2021) claims that new responsibilities of nurses are not limited by patient care; they are also responsible for charting and paperwork and providing insight into the health insurance industry. Nurses’ new functions will be conducted according to the standard introduced by the Affordable Care Act.

Medicare is the federal health insurance program directed to people above 65, young people with disabilities, and people with End-Stage Renal Diseases (Medicare, n.d). From this program, I received basic knowledge about parts of the Medicare program and the types of insurance. For example, Medicare Parts A, B, and D cover different insurance types such as Hospital and Medical Insurances and prescription drug coverage (Medicare, n.d). Moreover, during the course, I familiarized myself with the cost of each part and possible premium packages.

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The points I learned about the Medicare program will help provide insight into health insurance options during my future practice. Based on my knowledge, I could recommend possibilities that correspond to their health conditions and budgets. Moreover, this knowledge positively affects my general awareness about healthcare programs as a medical worker.

References

The affordable Care act and nursing. NurseJournal. (2021). Web.

Healthsherpa. (2020). Understanding metal levels and marketplace insurance. HealthSherpa Blog. Web.

State health insurance Marketplace Types, 2021. KFF. (2020). Web.

What’s Medicare? Medicare. (n.d.). Web.

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NursingBird. (2022, August 28). Discussion of Medicare Programm. Retrieved from https://nursingbird.com/discussion-of-medicare-programm/

Reference

NursingBird. (2022, August 28). Discussion of Medicare Programm. https://nursingbird.com/discussion-of-medicare-programm/

Work Cited

"Discussion of Medicare Programm." NursingBird, 28 Aug. 2022, nursingbird.com/discussion-of-medicare-programm/.

References

NursingBird. (2022) 'Discussion of Medicare Programm'. 28 August.

References

NursingBird. 2022. "Discussion of Medicare Programm." August 28, 2022. https://nursingbird.com/discussion-of-medicare-programm/.

1. NursingBird. "Discussion of Medicare Programm." August 28, 2022. https://nursingbird.com/discussion-of-medicare-programm/.


Bibliography


NursingBird. "Discussion of Medicare Programm." August 28, 2022. https://nursingbird.com/discussion-of-medicare-programm/.