Nursing Essay: Medicare, Medicaid, ACA Impact and Qualifications

This nursing essay delves into the complexities of Medicare and Medicaid, exploring their impact on medical billing, defining the qualifications for benefits, and analyzing the effects of the Affordable Care Act (ACA) on recipients. The essay highlights how medical billing errors can burden patients, pa...Read More

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NURSING 1
Medical care affects medical billing
Medical billing is considered as significant part of any medical services whether it is
medical care or medical aid. In country like United States, patients usually make use of their
medical insurance policy to pay bills or directly from their pocket. At present medical billing are
getting expensive due to involvement of advance technology and therefore it has become very
tough for patients to make payment for their medical bills (Gordon et al., 2019). As per the
study, it has been found that in recent years around 13% rise in medical cost. In addition it has
been found that more than half population owes almost $1000 or more money to their doctors. In
medical care one of the most affective elements is error in the medical billing which directly put
additional load on the pocket of the patient (Kacha et al., 2018).
Due to involvement of technology in medical service, small fault can lead to error in
medical billing. In addition, there is another possibility that medical staff may enter wrong code
which will direct impact medical billing on the patient. In some cases it has been found that
many mistakes happened by mistake such as one limb was diagnosed by bill was made for both
limbs while in some cases it can be seen that expensive diagnose bill was entered instead of
prescribed code (Liberman & Newman-Toker, 2018). In such situation, there are chances that
insurance company will reject clam of patient and can put patient in to strong trouble by
disturbing their economic stability. It has been found that in country like United States of
America, people spend great amount of their saving on medical insurance and in some cases they
even compromise with their basic requirements. In some cases, medical company intentionally
charge more in their medical service by structuring policy in such a way that patient will not be
able to understand the fraud in their medical services.
Qualification of medical care and medical aid benefit
In USA, qualification for medical care benefit is that the person must belong to age group
of 65 or above. In addition, medical care benefit also include young people with disabilities and
people which are suffering from end stage disease such a permanent kidney failure which require
dialysis. It also includes the permanent citizen of citizen if they really want this kind of medical
services. Medical care is also linked with two types of insurances, one is hospital insurance and
another is Medicare insurance (Stanhope et al., 2018). Hospital insurance benefits are offered to
those individuals who are around age group of 65 or older. In addition it also includes those
individual which are paying their Medicare taxes from almost 10 years. This kind of benefits is
also offered to people working in government offices. But when it comes to Medicare insurance
every individual has to pay to their service they may be 65 years old or suffers from some kind
of medical issues in any case they have to pay premiums related to the services in the form of
dedication from services associated with government. If person is not associated with
government service then a medical bill will be send to the person for availing these medical
benefits.

NURSING 2
Medical aid is a kind of social medical service which are offered to individuals which
belongs to low level income group of US population are not in a state to take medical insurance.
Medical aid is totally linked with government and government official forms the plan as per the
requirement to ensure that the needed individual may not be deprived from this medical aid
program. One of the biggest qualification to avail this service is that they must be belong to those
section of population which are struggling for their basic needs or are not even able to fulfill
their basic requirements (Chaiyachati et al., 2018). But still this service cannot be considered free
because someone has to face the cost of this service program and it is the government which
bears this cost. This kind of service is not directly offered to the needed person, there is always
middle man who offers this kind of service to the needed people. In this way, there are more
chances that will try to earn some extra from this social service offering. As the fund organized
by government for this service is not earned by government itself, it is being collected from the
USA citizen in the form of taxes. In simply words, it can be said that in any rise in medical aid
billing directly impact the pocket of every citizen which is part of United States circulation
system. In this ways, it impacts their financial pattern. This medical aid billing is often
distributed in every state of the US and in places where amount of service need is very low still
they are bearing the same cost.
Impact of ACA on medical care and medical aid receipt
It has been found that establishment of Affordable care act has changed the pattern of
medical care industry in various ways. One of the biggest impacts of this act is related to
benchmark legislation in upward trajectory of payments, deductibles and unaffordable cost,
exclusively when scheme is linked with medical insurance exchange. Medical plan were divided
in to gold and silver plan in which gold plan was going to impact by 13.8% increase on monthly
base. At the same time silver plan has also seen rise of 11.3% through the nation (Health player,
2019). This act forced medical care player to increase their expense while covering medical
services related to population which are suffering from some disease.
In medical aid service affordable acre act has impacted positively by covering around
millions of individuals which are not being insured because no days it has become unaffordable
for middle class family to take benefit of medical aid due to some specific reasons (Patel et al.,
2018). In this situation, it has motivated all the health care industry to spend more for humanity
so that every individual can take benefit of medical aid.

NURSING 3
References
Chaiyachati, K. H., Hubbard, R. A., Yeager, A., Mugo, B., Shea, J. A., Rosin, R., & Grande, D.
(2018). Rideshare-based medical transportation for Medicaid patients and primary care
show rates: a difference-in-difference analysis of a pilot program. Journal of general
internal medicine, 33(6), 863-868.
Gordon, L. G., Elliott, T. M., Olsen, C. M., Pandeya, N., & Whiteman, D. C. (2019). Patient out-
of-pocket medical expenses over 2 years among Queenslanders with and without a major
cancer. Australian journal of primary health, 24(6), 530-536.
Health player. (2019). How the Affordable Care Act Changed the Face of Health Insurance
[online]. Retrieved from: https://nerdyturtlez.com/tutor/order.php?id=1037591.
Kacha, A. K., Nizamuddin, S. L., Nizamuddin, J., Ramakrishna, H., & Shahul, S. S. (2018).
Clinical study designs and sources of error in medical research. Journal of cardiothoracic
and vascular anesthesia, 32(6), 2789-2801.
Liberman, A. L., & Newman-Toker, D. E. (2018). Symptom-Disease Pair Analysis of Diagnostic
Error (SPADE): a conceptual framework and methodological approach for unearthing
misdiagnosis-related harms using big data. BMJ Qual Saf, 27(7), 557-566.
Patel, M. R., Jensen, A., Ramirez, E., Tariq, M., Lang, I., Kowalski-Dobson, T., & Lichtenstein,
R. (2018). Health insurance challenges in the post-Affordable Care Act (ACA) era: a
qualitative study of the perspective of low-income people of color in metropolitan
Detroit. Journal of racial and ethnic health disparities, 5(1), 78-85.
Sessions, K., Hassan, A., McLeod, T. G., & Wieland, M. L. (2018). Health insurance status and
eligibility among patients who seek healthcare at a free clinic in the affordable care act
era. Journal of community health, 43(2), 263-267.
Stanhope, S. A., Cooley, M. C., Ellington, L. F., Gadbois, G. P., Richardson, A. L., Zeddes, T. C.,
& LaBine, J. P. (2018). The effects of home-based primary care on Medicare costs at
Spectrum Health/Priority Health (Grand Rapids, MI, USA) from 2012-present: a matched
cohort study. BMC health services research, 18(1), 161.