Social Determinants of Health have been Successfully Addressed by Medicare

Nowadays Medicare has become proactive and has come up with programs to address issues that affect people’s well-being more than their health like the money they earn, the place they live, and access to resources like fresh food and clean water. The CMS believed that by addressing these issues, healthcare costs for both Medicare and Medicaid beneficiaries will be reduced. It will also further promote public health programs to keep people healthier.

Social Determinants of Health Care

The U.S. Department of Health and Human Services has started an initiative Healthy People 2020 with the aim to decrease preventable disease, eliminate healthcare disparities, improve quality of life, and promote health for all people. The following five social determinants have been identified with this initiative that has affected people’s health.

Economic stability

People’s ability to pay for food, shelter, and other life essentials has a great effect on health. Jobs with a decent salary, stable employment opportunities, and access to job training are also important for economic stability.

Education

Individual’s health and well-being are affected by their education and literacy level. It is believed that people having more education will adopt healthier behaviors, as well as have more increased job opportunities.

Social and Community Context

It is believed that communities that have high rates of violence, crime, or discriminatory practices have a negative effect on health, whereas communities that are safe accept people of different cultures and are more likely to flourish and thrive.

Health and health care

People having access to health care, especially primary care are more likely to stay healthy and promote good health, as their chance of becoming ill will reduce.

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Neighborhood and built environment

People’s quality of life is directly affected by their ability to access local food markets, housing quality, and transportation. It will be really difficult for people to survive in areas having fewer resources and poverty.

Health Communities Model that is Accountable

Social determinants do affect people’s health, for instance, lack of food can lead to malnutrition along with some other medical complications and lack of housing can increase the risk for physical injury, and low income may lead to an inability to afford life-saving medications like insulin. These circumstances can make people sick or even worsen their chronic medical conditions, thereby increasing their need for healthcare services. People who are healthier are likely to have lower health expenditures. Thus, addressing social determinants of health are sure to improve health outcomes and reduce spending on healthcare. Due to these reasons, CMS came up with the Accountable Health Communities Model in 2017. The objective of this model is to close the gap and to raise awareness about these programs.

A total of 30 organizations are participating as of March 2020, which is receiving $1 million funds each year to use over a five-year period. Clinicians working in these organizations have been asked to identify local resources available to the people in the communities they practice. They also screen all Medicare and Medicaid beneficiaries to find whether their certain social needs are met or not. If their social needs are not being met then they will be referred to community organizations, who hopefully will address their needs.

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The fund provided by the government is not intended to develop community-based programs that directly address health-related social determinants. Instead, the Accountable Health Communities Model is developed to boost awareness and establish community partnerships. The model is expected to run for five years and then CMS will assess the effects on health outcomes and healthcare spending. In the future, the fund will be provided to expand those public health programs.

Medicare Savings Programs

Health’s biggest social determinant is financial instability; as low income makes it extremely difficult for people to pay for necessary medical care. Most people are unable to afford the cost of doctor’s visits or prescription medications. Thus, to help such people CMS has developed many programs that help them pay for Medicare premiums, copayments, coinsurance, and deductibles. The following four different Medicare Savings Programs have been designed to cover some expenses of Medicare Part A and Part B.

Qualified Disabled & Working Individuals

Not all Medicare beneficiaries are offered with the Medicare Saving Program. This program is designed for people under 65 years of age, who qualify for Medicare based on disability but are no longer eligible for premium-free Part A, when they start working again. Medicare Part A premiums are covered under this program.

Qualifying Individual

This Medicare Savings Program provides coverage for Medicare Part B premiums.

Qualified Medicare Beneficiary

It is the most extensive Medicare Savings Program covering Part A and Part B premiums, Part B coinsurance, Part B copayments, and Part B deductibles.

Specified Low-Income Medicare Beneficiary

This Medicare Savings Program provides coverage for Medicare Part B premiums.

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Individuals to qualify for any of the above Medicare Savings Programs should be eligible for if not enrolled in Medicare Part A. Besides, they also need to fulfill certain income and asset requirements.

Extra Help

Individuals who facing difficulty are paying for their medications can consider obtaining “Extra Help”. Extra Help is similar to a Medicare Savings Program that subsidizes medication costs for Medicare beneficiaries. However, to be eligible for this program, individuals should be enrolled in Part A or Part B, should be living in one of the 50 states or the District of Columbia, and also meet certain income and asset criteria.

There are two types of Extra Help Program. Full Extra Help is designed for the most needs, as it covers Part D premiums for plans that have premiums below their state’s benchmark amount. In the year 2019, individuals only need to pay a $3.40 copay for generic drugs, $8.50 copay for branded drugs, and no copay after $5,000 is spent in out-of-pocket drug costs.

Depending upon their income and assets, individuals may qualify for the Partial Extra Help program in 2019. Under this program, they will be required to pay a monthly premium depending upon their income, along with an annual deductible and a 15% coinsurance or plan copay, whichever is cheaper. After paying $5,000 in out of pocket costs, individuals will require to pay either a copay $3.35 for generic drugs and $8.50 for branded drugs or a 5% coinsurance, whichever is greater.

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