Alternative Healthcare Insurance Programs for Seniors Research Paper

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1 Introduction

1.1 Statement of the Problem

Lack of health coverage has been a prevalent issue in the United States. Research indicates that in the second year consecutively, there was an increase in the number of uninsured people. Insurance coverage and Medicaid are advantageous and comprehensive programs. However, numerous beneficiaries continue to struggle and face challenges in the enrollment and comprehension of their coverage. 

According to the Kaiser Family Foundation (2016), Medicare insurance plans facilitate the provision of medical and prescription benefits to more millions of seniors and disabled individuals. Also, there was the incorporation of the Medicare Plan Finder Tool to act as the point of accessibility for the selection and enrollment of Medicare plans. Nonetheless, several senior individuals have provided reports indicating challenges in utilizing the tool (Patel et al., 2009).

Moreover, numerous seniors are unable to reassess their coverage plans on an annual basis, and several eligible persons fail to enroll in the most suitable plan for them as a result of confusion concerning the several available plans. This intricacy gives rise to patients paying higher out-of-pocket costs than needed. 

Without a doubt, previous research demonstrates that older adults and seniors who have lower numerical competence and health knowledge skills have a less likelihood of choosing cost-minimizing plans. Moreover, they have diminished awareness levels and less likely to make application of cost-saving Medicare subsidy programs, which is worsened by the intricate plan selection setting (Hohmann et al., 2018).

1.2 Purpose of Program and its Impact

The program created will be called The Health Insurance Assistant Program. The purpose of the program will be to work directly with seniors who are either uninsured or struggling with coverage to obtain the benefits that they qualify for. Undoubtedly, in the contemporary setting, many programs are in place to assist those who need medical insurance. 

Taking into consideration that seniors are vulnerable and lack knowledge of coverage programs, they fail to seek their benefits. This program would educate them on every insurance benefit that they could qualify for as well as help them gain coverage. The workforce will work with every individual directly to create a profile and scan through all benefits that they would qualify for.

1.3 Overview of the Issue

Elderly persons face increasing out-of-pocket health care expenses and decreasing accessibility to health insurance. Off late, several uninsured adults have continued to increase, and this is bound to increase even further due to the baby boomers. Even though approximately three in five uninsured elderly individuals have employment, several of them lack eligibility for employer health plans or work for companies and employers that fail to offer medical coverage. 

Furthermore, taking into consideration that several states permit health insurers to charge consumers higher premiums based on their age and health status, several elderly persons and seniors have problems securing ideal health insurance coverage. Moreover, for seniors with insurance plans, the average out-of-pocket costs for premiums and health care are usually greater in comparison to the costs paid by individuals their age who have extra coverage from their employers (AARP, 2012).

In recent years, due to the ratification of the Affordable Care Act, with the inclusion of Medicare and Medicaid, seniors have been able to gain access to affordable health coverage. Notably, with the expansion of Medicaid, the federal health insurance program for underprivileged individuals and households, has been largely beneficial for low-income older adults. They, in the preceding times, lacked qualification for Medicaid and did not have access to or could not afford private insurance. However, despite these new set of circumstances, bearing in mind that seniors are largely susceptible and lack sufficient education and knowledge on these coverage programs and the information pertaining Medicaid, they are unable to capitalize on the coverage and the benefits that they qualify for.

Lack of mindfulness may be a momentous obstacle to participation by low- and middle-income seniors in pharmaceutical cost-assistance programs. Research studies that have examined health insurance literacy levels, the persons who faced the most difficulty, and the problem with comprehending health care are more likely to be 65 years or older as well as ethnic minorities (Paez et al., 2014). 

Research has shown that these senior citizens lack knowledge about and have a limited understanding regarding health insurance jargon, such as co-insurance, deductible, out-of-pocket maximum, prior approval, and formulary (Norton, Hamel, & Brodie, 2014; Vardell, 2019). In this context, lack of insight on such programs, especially amongst senior citizens and those accessing care in public medical facilities, could further worsen unequal access to health care coverage and access that has already been identified among the elderly (Vardell, 2019).

1.4 Target Audience

This program has key target audiences. First of all, the program targets elderly clients. They require assistance in gaining knowledge into precisely every insurance benefit that they could qualify for, as well as help them gain coverage. Secondly, the healthcare program also targets healthcare executives and administrators. Owing to the lack of awareness on the programs that they qualify, these elderly consumers end up paying more of their health plan premium and also face greater and costlier out-of-pocket (OOP) cost-sharing for all kinds of healthcare services. 

This impacts healthcare executives and administrators because the clients either choose not to visit their healthcare institutions in fear of the exorbitant prices or seek the services and struggle to pay them out effectively. Consequently, this program would be substantially ideal for healthcare executives and administrators because it would act as a tool to aid consumers to comprehend how to utilize their coverage, minimize their out of pocket costs, in addition to selecting and planning for care. 

2 Needs Assessment

2.1 Statement of Need

Off late, with the advancement of the Affordable Care Act, numerous programs have been put in a position to help the individuals that necessitate medical insurance. Senior citizens are specifically in need of these medical coverage programs. Older adults with inferior numeracy and health literateness skills are less likely to select an ideal coverage plant that alleviates cost and has minimal awareness on how to apply to the ideal cost-saving Medicare subsidy programs. Taking such susceptibility of senior individuals into consideration, they end up not capitalizing on all of their benefits. This indicates the need to educate, train, and provide them with sufficient insight into the various insurance benefits that they could qualify for in addition to assisting them to gain coverage.

2.2 Evidence

The number of the uninsured population in the United States with access to healthcare services at practical costs has been a societal and economic problem for their accessibility to healthcare services at a reasonable cost. Inadequate insurance coverage, increasing healthcare cost, and broadening inequality in access to healthcare services have unfavorably impacted senior citizens (Yamada et al., 2015).

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Borella, De Nardi, and French (2018) indicate that the intricacy of the Medicaid rules makes comprehension of eligibility challenging from a practical standpoint. Research evidence shows that elderly Medicare beneficiaries experiencing cognitive problems experience challenges in pinpointing the most meaningful and suitable option from an intricate set of coverage alternatives. As the elderly experience greater impairment in their decision making, this compromises the wellbeing of such beneficiaries and dissuade advantageous competition amongst Medicare plans (McWilliams et al., 2011).

According to Weiss Ratings (2018), statistics indicate that over 50 percent of seniors enrolling in Medicare experience the selection of the appropriate plan perplexing, and more than 35 percent of the seniors not ready to select a Medicare plan that is suitable for them. Jacobson and Swoope (2014) indicate that for numerous seniors, choosing an initial Medicare plan is an unpredictably challenging task. Annually, Medicare plans may alter their premiums, benefits, and additional characteristics, and beneficiaries have the chance to examine such changes, and if considered essential, alter plans in the course of the yearly open enrollment period. However, it is perceptible that very few seniors reassess their coverage decisions every year to ascertain the best choice for them centered on their personal needs and the distinctive features of the plans accessible to them.

2.3 Theoretical Basis

The theory of health literacy guided my identification of the issue. Health literacy, from a reductionist point of view, could be perceived as a supplement of individual abilities proficiencies necessitated processing and follow up on health information. On the other hand, such a restricted standpoint needlessly eliminates the individual from the wide-ranging selection of social forces that influence health. Without a doubt, an ecological method offers the contextualization necessary to pinpoint persons with changing magnitudes of health literacy and create long-term resolutions to diminish the adverse health consequences of poor health literacy (Ross et al., 2009). 

An efficacious strategy to augment health literacy ought to integrate multi-level interventions that, from a practical standpoint, promote affiliations individuals and their households, educationalists, health providers, and interested community parties, and policy-makers at the local, state, and federal level (Ross et al., 2009). 

Health literacy is the magnitude to which persons can acquire, process, and comprehend fundamental health information and services necessitated to make suitable health decisions. Enhancing health literacy is progressively more important information, selections, and decisions regarding health care and public health have advanced to be more intricate. Greater accessibility and understanding to reliable health information can provide palpable benefits to patients and consumers who regularly must make minor and major health decisions (Centers for Disease Control and Prevention, 2009).

3 Resource Allocation

Resource allocation alludes to the process of apportioning and scheduling the available…

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…for Measuring Success

6.1.1 Customer Satisfaction Survey

This is one of the methods for measuring success to attain a comprehensive description of how the organization and potential funders will know the program is successful. The main goals and objectives of this customer satisfaction survey will be to measure satisfaction with the Health Insurance Assistant Program. The survey will be beneficial in conducting an assessment on how customers value the services rendered and the information they obtain from the program, to ascertain the prospects for continued improvement, and to guarantee that the program is in full compliance with regulatory requirements concerning data gathering. Execution of the survey will be carried out at the end of the year. It will be undertaken for three years consecutively to determine success (U.S. Department of Health and Human Services, 2016).

6.1.2 Health Insurance Assistant Program Training Meeting

This particular method of evaluation will be largely beneficial in rendering support, assistance, and information to the directors and staff of the Health Insurance Assistant Program. Specifically, the training meeting presents the chance to assess the core and fundamental values and practices that explain the program and improve new proficiencies to reinforce the programs' outreach determinations and the engagement of the senior individuals. What is more, the training meeting will also facilitate the ability to carry out networking in addition to sharing best practices with other institutions in other states and expenses, staff, and national partners (U.S. Department of Health and Human Services, 2016).

6.1.3 Data System

Data gathering will also be facilitated through the development, implementation, and operation of a data system for the program to enhance the program's performance capacities further. The new system will offer the program additional flexibility in reporting and data analysis in comparison to the prevailing manual systems and will be specially designed to support the operations of the Health Insurance Assistant Program in the coming years (U.S. Department of Health and Human Services, 2016).

6.2 Plan for Data Collection

Health care encompasses a diverse range of people. This program will encompass both public and private data gathering systems. This will comprise of health surveys, medical records, organizational enrollment, and billing records that are employed by various health care facilities, including hospitals, physicians, and also community health centers. Notably, data touching upon the elderly's racial and ethnic background will be collected, which is indicative of the potential to add information on patients and enrollees (Agency for Healthcare Research and Quality, 2020). The information management system, in addition to health information technology, will facilitate the enhancement of the collection and interchange of client data. Furthermore, the data will be gathered using questionnaires. Specifically, the questionnaires will be used to determine the senior citizens experiencing difficulty in gaining access to medical care, comprehending the different insurance plans offered to them, the plans that they qualify for, and also the challenges faced in payment of the care.

Conclusion

The challenges of understanding and gaining extensive knowledge regarding health information are particularly massive for the increasing rate of individuals aged 65 years and older in the United States. It is imperative to note that older adults experience chronic diseases and necessitate more health care services in comparison to other age brackets of the population. They experience distinctive issues associated with physical and cognitive functioning that can make it daunting for them to obtain and utilize suitable health information. .....

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