preview

Health Care Case Study

Decent Essays
All new health insurance plans are required to cover recommended preventive services and immunization without cost sharing. The preventive services fall into four categories. 1. Services with certainty of providing substantial or moderate net health benefit (grade of "A" or "B") this is determined by U.S. Preventive Services Task Force (USPSTF) items or 2. Immunizations recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) 3. Evidence-informed preventive care and screening guidelines for infants, children, and adolescents recommended by the Health Resources and Services Administration (HRSA 4. Additional preventive care and screening services for women recommended by HRSA…show more content…
Thirty one states and DC that have chosen to expand Medicaid, individuals with household incomes up to 133% of the Federal Poverty Level (FPL) qualify, and the federal government finances part of the cost. However some states including Indiana opted out of Medicaid expansion. This has resulted in askewed coverage of preventive services across Medicaid population. in states that expanded Medicaid, individual have access to preventive services. States can decide which preventive services to cover and whether to require cost sharing (Seiler, Horton & Dafflitto 2014 p 531).
Individual mandate All individuals are required to have health insurance, failure to obtain coverage leads/ results in financial penalty of the greater of $695 per person (up to a maximum of $2,085 per family), or 2.5% of household income, which was phased-in from 2014-2016. Exemption can be made on grounds like financial hardship or religion objection (Kaiser 2102)
Health insurance market place
In order to expand coverage. The ACA requires each state to establish health insurance Marketplaces or exchanges so individuals can compare health insurance options and purchase insurance ((Shi and Singh, 2015 p.212). (Teitelbaum & Wilensky, 2013, p.171). The ACA requires all Marketplace plans and Medicaid expansion programs to cover ten categories of “essential health benefits” (EHB).
This is to ensure there is reduced variation and adverse selection of coverage or
Get Access