Health Care Finance (Essay Sample)

Health Care Finance
Name
Institution
Health Care Finance
Insurance offers convenient ways of financing healthcare services. Through its principle of pooling risks, insurance allow patients to enjoy costs sharing where one does not have to bear the full amount for health care received (Ulmer et al., 2012). In the U.S, lack of insurance is a major setback for people getting access to quality health care. According to researches, a majority of the U.S population receive less than 60 % of recommended health care, which is attributed to lack of insurance services (Bodenheimer, 2005). This paper seeks to discuss the various sources of health insurance coverage for various groups of people in the state of New York.
Seniors age 65 and older: In New York seniors citizen are eligible for various options of health care insurance. These include Medicare by the federal government and the Elderly Pharmaceutical Insurance Coverage (EPIC) program administered by the state’s Department of Health. EPIC cater for costs of drugs while Medicare cater for other medical care services such as tests and items.
Children younger than 18: In New York, children are eligible for Children’s Medicaid and Children's Health Insurance Program (CHIP) such as Child Health Plus (Ulmer et al., 2012). Medicaid provides access to health care at no cost while Child Health Plus charges low costs health coverage. Both of them cater for routine check-ups, dental care, prescription medications, and immunization among others. Unlike Medicaid, which can be access by poor people, a child’s family income is a determinant factor to be eligible for Child Health Plus, which is accessible for only those who can afford it (NY State of Health, 2013).
Low-income families with at least one child, whose family income is below 133% of the Federal Poverty Level: Every state in the U.S provides Medicaid to cover for poor families who cannot afford to pay for medical care. Medicaid can be run jointly with CHIP to cover children of below the age of 18, from poor families (USA.gov, 2014). However, New Yorkers may be forced to co-pay for other medical services that are not fully covered by Medicaid at a maximum cost of $200 co-payment per year (NY State of Health, 2013).
The self-employed: In New York, self-employed persons can apply for Medicaid for their health care coverage. Other available option is to seek suitable self-employed health insurance cover from the Marketplace, suiting one’s medical needs (NY State of Health, 2013). In some cases, self-employed persons can utilize other options such as spouse’s insurance, to provide health care coverage for themselves.
Employees of large companies (more than 100 employees: Large companies have some planned health care system for their employees. Insurance companies in the Marketplace can facilitate such a job-based health plan, allowing employees to enjoy certain health care coverage that a majority would not have afford were it not for the employment. In New York, employed persons are not eligible for Medicaid (USA.gov, 2014). Employers insure their employees not only as requirement by the federal law, but also for maintaining a healthy and satisfied workforce, for efficiency within the organization. Some work-based insurance plans cover employees plus their other direct family members.
Employees of small businesses: Small business owners can arrange a Small Business Health Options Program (SHOP), with an insurance company in the Marketplace to provide health coverage for his/her employees (Ulmer et al., 2012). In other cases, depending on the agreement between the employer and the employee, the employee can arrange their own insurance cover.
Part-time, temporary, and seasonal employees: In New York, Employment Medical Plans can be arranged to provide health cover for part-time or seasonal employees. In this, the selected insurance company in the Marketplace can cover for specific health care at the time when the employee is working for the company or business (USA.gov, 2014).
The unemployed: If a person is unemployed in New York, this makes him/her qualify for two types of health coverage, which are Medicaid and a private health insurance plan, from the Marketplace coverage. For one to qualify for New York Unemployment Insurance benefits, one must have worked in the state for the past 12 to 18 months (NY State of Health, 2013).
College students: In New York, college student can benefit from their school’s student health plan to cover for their medical expenses (USA.gov, 2014). Others, especially those who can afford it, may seek private student health insurance form the Marketplace.
People of age 65 and above applying for Pharmaceutical Insurance Coverage (EPIC) contribute to the premiums of their health insurance. This is in addition to extra co-payment for drugs costs, which have to be met by both the insurance company and the patient. For children applying for Child Health Plus, monthly premiums vary depending on the family level of income with the premiums ranging from $9 to $60 per child per month (NY State of Health, 2013). In Medicare, those enrolled are normally deducted $20 from their salaries as their monthly contribution. For those subscribed to Medicaid, their monthly con...