Disability Insurance Case Study

No one plans to have oneself or a family member diagnosed with a chronic disease or to be involved in a debilitating accident. Unfortunately, these situations are all too familiar and can happen every day. Having health insurance when these life changing events occur can provide a person or family

Under the Act, each provincial health plan is administered at the provincial level and provides comprehensive first dollar coverage of all medically necessary services. With minor exceptions, health coverage is available to most if not all residents with no out of pocket charges. Most physicians are paid on a fee for services and enjoy a great deal of practice autonomy. Private health insurance for covered services are illegal.  Most Canadians have supplemental private insurance for services that are not covered, such as prescription drugs and dental services. Consequently, physicians are forced to participate and each health plan effectively serves all residents in the province (Henderson 487).

You have open access to indemnity insurance. You have the right to choose your PCP and it doesn’t matter what your insurance may like. This makes things very convenient considering many people go to the same doctor for the vast majority of their life and solely rely on them for their treatment or care.

Unit 2 AssignmentKelley WhitcombKaplan UniversityHI215-01: Reimbursement MethodologiesProfessor Kathleen SobelJuly 20, 2015Medicaid is one of the biggest insurance plans you can get in any state. In the state of Indiana, it is based off of your income. There is a certain amount (income) you have to make to determine if you will receive Medicaid or Healthy Indiana Plan (HIP). HIP is still a form of Medicaid, but you would have to pay monthly cost for it and have certain set of co-pays for certain services that is needed. HIP Plus is the recommended plan for members as it provides health coverage for a low, predictable monthly cost. HIP Plus also covers dental and vision services. If you do not pay your monthly payment you can be removed from

Medicare provides access to health insurance coverage for more than 45 million people who qualify due to disability or age. The three components of Medicare are Parts A, B, and D. Part A is hospital insurance and provides coverage for inpatient hospital services, skilled nursing facility services, hospice services, and post-institutional home health care. Covered services under Part B one component of supplementary medical insurance (SMI) include physician services, durable medical equipment, laboratory services, outpatient hospital services, physician-administered drugs, dialysis, and certain other home health care services. The other component of SMI, Part D, mainly provides access to prescription drug coverage through private insurance plans.

Such coverage would allow him to receive weekly or monthly income payments to replace the income he will not receive when he is unable to work as a result of a covered illness or accident. Since Zach has already been unable to work for two months and will likely be unable to work for another few months while recuperating at home, some form of disability income insurance is probably needed. In addition to Social Security benefits, which do not begin until a worker has been totally disabled for five months, and worker's compensation, if he is eligible, some type of long-term disability income coverage is needed. Since the really catastrophic events for which disability insurance is most important require long-term coverage, he would probably be better off purchasing a disability income policy with a longer waiting period and longer duration of benefits. In summary, Zach should evaluate his disability income coverage and fill in any gaps that may exist, particularly in the area of long-term disability income insurance.

However, the coverage Medicare provides comes with premium and cost-sharing requirements as well as gaps in covered benefits, especially for long-term services and supports (LTSS). As a result, Medicare coverage often is supplemented by additional coverage from retiree benefits, Medigap policies separately purchased, and, for low-income beneficiaries, Medicaid (Rowland, 2015). Now, the eligible Medicare beneficiaries can choose between managed care and indemnity plans. Medicare managed care program, Medicare advantage plan, promoted new forms of managed care that were more like traditional insurance policies than like HMOs.

Medicare is a health insurance program purposely created for people over sixty five (65) years of age. However the service is open to people with certain disabilities or permanent kidney failures. The process of choosing the right Medicare involves having to weigh different plans on account of benefits of their cover. Different types of Medicare plans are important in: Inpatient hospital care, outpatient services, doctor visits, home health care, prescription drugs, and care in a skilled nursing facility among others. In addition, the program covers the cost of health care but does not cover all medical expenses including cost of long term care. If one ought to choose an original Medicare coverage, one may buy a Medicare supplement policy from a private insurance company to aid in coverage of costs that are not supported by Medicare. Most of these Medicare expenses are covered by a part of the pay role offered to workers by their employer. This paper covers different Medicare plans; A, B, C, D and their influence towards my decision on the best preferred option.

The state healthcare marketplaces have increased new insurance companies in their markets and many of these state healthcare marketplaces will increase new health plans as well. These additional physician opportunities will be imperative for them to understand how the contracting process affects their practices.

Older adults who are reaching the retiring age have the important job to make decisions regarding the Medicare coverage plans. “Medicare is an insurance plan for person who are age 65, blind, or totally disabled, including those with end-stage renal disease” (Touhy & Jett, 2011, p. 394). Medicare is composed of four different parts. Part A and Part B are the original plans, Part C represents the advantage plans and Part D is the prescription drug plan. (Touhy & Jett, 2011). Choosing the right Medicare plan requires comprehension of the different plans available for qualifying individuals, coverages, deductibles, premiums, and supplemental insurance policies. The information in the Medicare plans is extensive and often times confusing for older adults especially those who have cognitive problems coupled with other comorbidities and geriatric conditions such as hearing and vision problems. In order to make informed decisions, older adults must take on the challenge to learn about the Medicare plans, what is covered, terms and conditions, and out of pocket costs.

 An employee must be provided the same level of medical benefits, disability insurance and leave as are offered for other medical conditions or disabilities.

Other programs under DM that have shown to be beneficial to both the members and the health plans are, shared decision-making programs and medical informatics. PPOs, HMOs and CDHPs have preventive services programs being implemented. Preventive services include services such as: immunizations, mammograms, physicals, and counseling. An independent study on an indemnity plan that had prenatal preventive services showed that members who enrolled into this program had an average of $3200 less per delivery than those who had not (p.194). Health risk appraisals are a program geared to obtain information from members regarding activities or behaviors that can affect their health status (Kongstvedt, 2007,p.193). When the health plan obtains this information it

The higher cost of affordable Health care is also eroding the ease with which to afford other insurance that covers about 30 percent of Medicare enrollees ‘expenses. In 2005, about 89 percent of beneficiaries obtained such additional coverage, including through former employers (33 percent), medical policies (25 percent), Medicare advantage plans (13 percent), Medicaid (16 percent), or other programs (1 percent) (MedPAC). These supplemental insurance programs were all very helpful at the onset, but with the passage of time and as health care costs continued to rise, employers are finding it difficult to support these programs and as a consequence, a greater number of these employers are either reducing the benefit or eliminating these benefits especially those that affects their retirees thereby increasing the cost of these supplemental insurances.

The drawbacks from these insurances (HMO, PPO) are you have a limited to select from a network of physicians, therefore if you changed professions and had to work somewhere else that offered a different insurance which your current doctor did not participate with, you would now need to switch over to someone

Most view medical and dental coverage as the most important option within their benefits package. Medical coverage usually includes doctors visits,