National Health Coverage Plans, Reimbursements, and Quality

Running head: NATIONAL HEALTH COVERAGE PLANS 1
NATIONAL HEALTH COVERAGE PLANS, REIMBURSEMENTS, AND QUALITY
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NATIONAL HEALTH COVERAGE PLANS
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NATIONAL HEALTH COVERAGE PLANS, REIMBURSEMENTS, AND QUALITY
Introduction
Healthcare coverage is a form of insurance in which the insured individuals can claim
payments for their healthcare expenses. In the United States, healthcare coverage is provided by
a number of private as well as public sources. Some people have multiple insurance sources to
take care of their health expenses (Bauchner, 2017). Having health insurance is important to
avoid upsetting one’s finances in the case of accidents or medical emergencies. A health
insurance policy can cover a range of expenditures including ambulance charges, consultation
fees, cost of medical tests, hospitalization costs as well as post-hospitalization costs to an extent.
This paper discusses two major healthcare coverage plans in the US and the care options under
each. It also discourses healthcare coverage in relation to the vulnerable population. In addition,
the paper deliberates the purpose of diagnosis-related groups and the role of charity care within a
healthcare facility.
Healthcare Coverage and Vulnerable Populations
The passage of the Patient Protection and Affordable Care Act (PPACA) in 2010
increased health coverage by extending insurance to numerous low-income persons and offering
subsidies (Irons & Moore, 2015). This led to a decrease in the number of nonelderly Americans
who were uninsured. However, even with this policy, several people remain without healthcare
coverage due to the high cost of insurance in the country (Krueger & Kuziemko, 2013). Many
individuals do not have access to healthcare coverage via employment while others did not
extend their insurance even after enactment of the policy and thus are not qualified for financial
assistance to cover their healthcare expenses. Also, others who are eligible for financial aid are

NATIONAL HEALTH COVERAGE PLANS
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not aware that they can access help. Immigrants who are not documented in the US are not
eligible for healthcare coverage ((McIntyre & Song, 2019).
Healthcare insurance can be helpful to the uninsured population by:
Enhancing their accessibility to care: uninsured individuals may be unable to obtain much
needed medical care as a result of the high cost. In addition, as compared to the insured people,
they are less likely to access disease preventive services for chronic illnesses and other major
health conditions (Bauchner, 2017).
Avoiding or reducing financial problems: snowballing medical bills can easily lead to
debts that strain one’s finances. This is intensified by the fact that most of the insured individuals
have moderate or low income and may have little savings if any. Having coverage can thus help
the uninsured avoid medical debts that are bad for their finances.
Medicare
Medicare is a United States’ national health insurance program administered by the
Centers for Medicare and Medicaid Services (CMS). It offers healthcare coverage to people with
amyotrophic lateral sclerosis (ALS), young people with disability as identified by the Social
Security Administration, individuals with end-stage renal disease, as well as those aged 65 years
and above (Bauchner, 2015).
Care Options that Facilitate Patient Access
Medicare Part C provides coverage for all services according to the original Medicare
part A and B whereby the insurance was on a fee for service basis. Medicare part B offers
medical insurance on numerous services such as diagnostic tests, x-ray, renal dialysis, blood
transfusions, and organ transplants. These two programs facilitate patient access due to the range
of medical services provided.