Monday, October 22, 2018

The state of the American health care system has been the subject of much controversy for several years. That’s because the situation has been deteriorating for quite some time and no dearth of data can prove it. Olga Khazan at The Atlantic highlighted a report showing why American health care performs so poorly compared to its rivals. Worse still is the fact that the US outspends them all. “The ways to fix these issues,” according to the experts who authored the report, “are to increase the rate of insurance coverage and access to primary care, streamline the insurance system so that there are less administrative hurdles for doctors, and funnel more money toward better nutrition and housing.” The numbers and conclusions are compelling but they fail to emphasize how entrenched our issues really are.

Austin Frakt at The New York Times published a provocative article tying Reagan era deregulation to skyrocketing health care costs. He draws attention to specific legislative decisions made during the 1980s that precipitated our current dilemma. Unlike our European counterparts, the US elected to abandon state-mandated price controls and instead opted for market-driven measures. In other words, the health care system was privatized. The rampant advertising of prescription drugs was another major contributing factor. Underfunding of social services relative to projected health care costs sealed the deal.

Flash-forward to February 2018. Yasmeen Abutaleb at Reuters announced that the US is expected to spend $3.5 trillion on health care this year. Her article is brimming with dismal statistics. One key takeaway was the aging baby boomer generation, which will increase enrollments in Medicare and further strain the Social Security system. Another unfortunate fact was that a higher share of the population is expected to be uninsured by 2026.

This is all to say that no resolution is likely to unfold anytime soon. The best we can do in the meantime is arm ourselves with enough knowledge to navigate the existing system with confidence. Understanding what resources are available to the public is the first step. The two most common are Medicare and Medicaid. Staff writers at the US Department of Health and Human Services have provided explanations on the difference between Medicare and Medicaid.

Medicare is an insurance program whereas Medicaid is an assistance program. Both programs help individuals absorb expenses but differ in how they do so and whom they aim to support. Medicare is run federally and meant for those “over the age of 65, whatever their income; and serves younger disabled people and dialysis patients.” Medicaid serves low-income people of every age but eligibility varies depending on where people live because the program is jointly run by each state and federal government.

Those interested in Medicare have countless resources devoted to helping them. One thing to consider is the Medicare Special Enrollment period, which allows individuals to opt in or change their existing Medicare plan based on special circumstances. That might include an unexpected job loss and/or already having to support an ailing family member. Either way, it’s important to recognize that exceptions to standard enrollments are made within the framework of each program. That isn’t something found in most privatized insurance plans.

You also might be eligible for both Medicare and Medicaid. The programs are not mutually exclusive. But, because Medicaid is administered jointly by each state alongside the federal government, you must consider the implications. Moving from one state to another would demand exploring eligibility requirements all over again. Traveling to another state for a health care procedure could also have repercussions on eligibility and/or the ability to tap into program benefits. Fortunately, all Medicare and Medicaid programs have agents trained to help people navigate the process. Third parties can assist those unsure of how to begin. Never underestimate the value of utilizing a someone knowledgeable.

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