Read and respond to at least two of your classmates’ discussion posts. Be constructive and professional with your thoughts, feedback, or suggestions. 125 words each pos
1. In the state of CA medicare patients are fully covered as long as they have medicare A&B, as long as its medical necessity. The patients won’t know until after the procedure if they’re responsible for that procedure or not. With Medicaid you know what you are getting into because you have to submit the cpt code to see of you need to submit a TAR or not and they’ll either approve it or deny it, but at least you know prior to you getting the procedure. That way you can see if you want to pay out of pocket or not, that you don’t have to worry about a surprise payment that you will have to pay.
Many states deliver services to Medicaid beneficiaries via managed care arrangements. Federal regulations at 42 CFR 438 set forth quality assessment and performance improvement requirements for states that contract with managed care organizations (MCOs) and/or prepaid inpatient health plans (PIHPs). These requirements include the development and drafting of a managed care quality strategy and the performance of an external quality review (EQR).
2.I reviewed the healthcare.gov to review the current insurance coverage for my state. I reside in Arizona, the medicaid plan is called Arizona Health Care Cost Containment System (AHCCCS). There are a number of health plans beased on the service area. The requirement for AHCCCS coverage is by the income and the number of persons in the household. The household income is based on the Federal Proverty Level.
Some of the things that is needed to apply for AHCCCS is Proof of who you are, whether it is proof of citizenship or an alien registration card. Another information needed is the social secuirty card and birth certificate. The last payment stub from previous employer to provide proof of income.
The Marketplace insurance is an option per the healthcare.gov website. It really depends on what type of coverage you get to determine what your out of pocket monthly premiums would be. The formula that they use is a lower deductible plan, it would be a higher monthly preimiums per the month.
The things that I learned from my state of Arizona is that their is Medicaid, Arizona Health Care Cost Containment Systems (AHCCCS) is availble for lower income individuals and their families.