Health Insurance Plans for Individuals with Chronic Illness

This essay discusses the case study of a 34-year-old single male with HIV positive and alcoholism, exploring the appropriate health insurance plan for him. It compares Medicaid and private insurance schemes in the United States and analyzes their coverage and benefits. The essay concludes that Medicaid in Nevada or Texas would be the most suitable plan for the individual.

Running head: HEALTHCARE
Healthcare
Name of the student
Name of the university
Author’s Note

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Introduction
Health care insurance plans are the categories of the insurance that covers the costs of the
insured individual’s surgical and the medical expenses. These are the programs that covers the
whole or the partial tenure of the risk of the person who has been incurring the expenses of the
medical. The essay highlights the case study of a 34 year old single male who has been
diagnosed with HIV positive and has been recently initiated to recover from his alcoholism. Due
to the lack of his abilities and the actions towards his capabilities, he has been in utter depression
regarding his inability for finding employment (Barnett &Vornovitsky, 2016). The thesis
statement of the essay argues with the fact that what health insurance plan will be appropriate
for the man of the case study. The essay highlighted both the Medicaid insurance and private
insurance schemes of the United Sates and argues on the fact that which ne will be good enough
for the person in the case study.
Discussion
The case study illustrates the scenario of the 34 year man suffering from the chronic
illness of HIV positive. He is single and also been unemployed thus it has been getting difficult
for him to manage his own expenses that includes rent, medical expenses and other necessities
for living (Condray& Devine, 2017).
In this section of the report the health insurance scheme of the United States will be analysed
followed by the justification regarding the chosen medical insurance plan both the public one and
the private ones.
The insurance plans

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In this section the United Kingdom health insurance plan that will be discussed are the
following.
The Medicaid health insurance program - this health insurance programme provides free
or very low cost health coverage to the people and the individual belonging from low income
families. This families and the coverage includes the children, the pregnant women, the elderly
and the people or the individual with disabilities (Cohen, Martinez &Zammitti, 2016).The
Medicaid program is jointly funded by the federal government and the states. For the effective
participation of plan, each and every state of the United States are required to offer the Medicaid
program to all the persons regarding the public assistance (Holahan et al., 2017). Beside from
this with the consideration of the broader range of the federal guidelines, the individual states
determine the eligibility towards the enrolment in their own set of programs with the program of
the Medicaid generally offered to the persons whose rate of income falls under the certain level
(Carman, Eibner& Paddock, 2015). Under the federal law, each and every state of the United
Stets provide the facility of the Medicaid that includes the services related to the inpatient
hospital, the services related to the outpatient hospital. Furthermore the services and the coverage
in the Medicaid includes the early and periodic screening, the diagnostic treatment service, the
nursing facility services , the x ray and the laboratory services (Obama, 2016). Besides the
general benefits some of the optional Medicaid benefits includes the prescription drugs, clinical
services, optometry services, personal care, care facility for the mental diseases and intellectual
disabilities.
There are certain private health insurance in the country of United States. This accounts
for more than 30 percent of the health care financing. Majority of the private insurance des not
adhere to the Canada health acct and does not cover the prescription drugs, the home care and the

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long term care (Singleterry et al., 2015). The costs incurred for the private insurance in the
United Stes includes the monthly premium and the amount as deductible or the excess. Some of
the example includes $2000 deductible for the costs of the treatment. The private insurance of
the country furthermore includes the co-payments for different categories and types of payments
(Courtemanche et al., 2017). In the respect to the promise of the quality care treatments and the
high quality care, the private insurance of the states of the country are far more expensive as
compared to the government plan of insurance that is the Medicare and the Medicaid. Most of
the coverage for the insurance are for domestic treatments only and the additional coverage and
the mandatory health tests including the x-ray and the blood tests are not included in the
premium schemes of the private insurance plans.
Justification for the chosen plan
For gaining of a better idea regarding how the Medicaid health insurance can differ from
one state to another, three states in the United States has been reviewed in this section.
The coverage in Nevada
The Medicaid policy of this state provides quality health services to the low income people on
the basis of the federal and the state laws. The Medicaid policy of this state covers the individual
from the families with the income below 200% of the federal poverty level. The requirements for
enrolment into the Medicaid policy in Nevada involves that one must be a permanent resident of
the state, a US citizen, a legal alien, someone needing healthcare or insurance assistance. In case
of the maximum income level, the household size of one must have 16,000 dollars per year while
the household size of eight must have 56,000 dollars per year as maximum income level. The
Medicaid policy of the state includes the home based Habilitation services, the hospital care, the

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mental health and the substance abuse services, the preventive screenings, the specialists and
more (NationalCenter for Health Statistics, 2015). By December 2018, the state has enrolled over
636,200 individuals under the Medicaid policy, which is an increase of over 91% from the first
Medicaid program changes introduced in October 2013.
The coverage in Texas
The state includes both the Medicaid and the CHIP services in the state. Apart from the general
insurance schemes, the state provide three of the major Medicaid programs that include the
STAR, STAR + PLUS, STAR HEALTH. Similar to the state of Nevada, the state of Texas also
requires the policy applicants to be permanent residents of the state, legal alien and such
including financial income as characterized low of very low. The maximum income level per
year for qualifying for this policy is $24,037 for household size of one and $83, 912 for
household size of eight. The type and the category of the coverage of the Medicaid in the state
depends on the living, the health issue of the person in concern (Barua et al., 2015). While the
STAR Medicaid coverage includes the children, the newborn and the pregnant women, it also
includes individual or adults above 20 who have disabilities. The adults with disabilities caring
for a child are also qualified to have Medicaid. The STAR +PLUS is specifically for the people
suffering from different types of disabilities and this plan helps them to get long term care
services through the health plans or the managed care plans. The state has also revised its plans
to include children of foreign parents under the Medicaid coverage. The step was taken after
reports of children of lawfully residing foreign parents were denied the Medicaid program owing
to the income of their sponsors. Texas made the decision to make the changes after consulting
with the state officials and the CMS.

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The coverage in New York State
The Medicaid state plan is generally administered by the NY Department of Health. In the state,
the services related to the health care activities are generally paid for by the Medicaid but some
of them may not get covered for certain parameters like the age, the financial circumstances, the
situation of the family, the transfer of the resource requirements and the arrangements of the
living (Grogan et al., 2016). Some of the Medicaid services in this state includes small co-
payments. These small payments services might be offered to the people by using their Medicaid
card or through their managed care plan given; they are enrolled under the managed care. The
requirements for benefitting from the Medicaid plan are the same as other mentioned states.
However, the household size and maximum income level per year is different. For the state of
New York, a household size of one must have maximum income level of 15,000 dollars per year.
For a household size of eight, the maximum income level must be 54,000 dollars per year.
Among the Medicaid services of the three states, the most suitable one for the individual of the
case study , the Medicaid services and the coverage in Nevada followed by that of in Texas
(Jarlenski et al., 2017). The table below highlights the comparative status of the Medicaid policy
within three state to highlight the suitable Medicaid policy for the individual in the case study
under discussion.
Table of comparison
Factors Nevada Texas New York State
Premium Free and very low Medium High since many of the
services require co-

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payment options
Deductible No Partial Yes
co-payment for primary
physician
There is no co-
payments
There is no co-
payments
There is additional co-
payment options
Referral No Yes Yes
Coverage for formulary No pre authorization
needed
No pre authorization
needed but need to
place the individual as
per the Medicaid
programs and schemes
Formulary on the basis
of pre authorization
Choice of Physician Yes As per availability The choice of
physicians is
chargeable
Common diagnostic
tests
No pre authorization
needed for common
diagnostic test like X-
ray
No pre authorization
needed for common
diagnostic test like X-
ray
Pre authorization
needed for common
diagnostic test like X-
ray
Cost for hospital
coverage
No cost for hospital
coverage
Partial costs for
hospital coverage
There includes some of
the relevant costs
regarding the cost for
the coverage in the
hospital

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Excluded benefits like
vision, dental and
alternative therapies
Yes Yes Yes but one have to
hold benefit
identification card
Other information Includes services
related to rehabilitation,
immunizations,
physical therapy and
more
Treatment of special
health needs and
vaccines
Care and treatment
through home health
agencies and personal
care together with the
inclusion of the costs
related to the
transportation to the
medical appointments
Conclusion
Thus from the above discussion it is evident that the individual suffering from
unemployment and HIV positive as per the case study will be benefitted only from the public
insurance scheme of Medicaid. This is because the principles and the factors embedded in the
ACA/ Obamacare has stated easy access to Medicaid for the people suffering from chronic
illness just like the individual in the case study. As mentioned in the discussion above, other
states like Texas, Nevada and New York also have Medicaid coverage for the citizens. While the
Texas state provides coverage to new born, pregnant women and adults with disabilities, the
New York state has limited coverage. It restricts the coverage to age, family situation, financial
circumstances, living arrangements and transfer of resource requirements. The Nevada state on
the other hand, provides Medicaid facilities to families whose annual income is up to 138 percent

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of the federal poverty level. The three states covered in the discussion have similar requirements
for people to avail the Medicaid program benefits although their household size and maximum
income level differs. The Medicaid insurance plan in the state of Nevada followed by Texas will
be the most appropriate for the individual suffering from HIV positive and alcoholism. This is
because the Medicaid service helps the individual of the state to recover from depression,
rehabilitation services, drug addiction and other chronic illnesses.

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