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U.S. Health Care Delivery System Essay Sample

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U.S. Health Care Delivery System Essay Sample

The type of health care coverage that I currently have is TRICARE Standards. This is the most flexible option available to TRICARE-eligible beneficiaries. It is a fee-for-services option which gives beneficiaries opportunity to see any given TRICARE-authorized provider (Military.com Benefits, 2010). This coverage is not available to active duty service members and those who subscribe to the coverage share cost o medical care from civilian providers in case there is not military treatment facility nearby.

TRICARE-standard may be used as a primary or second coverage for retired military officers. TRICARE standard is preferred by most retirees when they live in an area where TRICARE prime network is not available. The source of my coverage if Government Retried Army. Since there are co-payments to be made, additional payment comes from personal out of pocket expenses.

My total out of pocket cost amounts to $12. This is in addition to the amount of deductibles which amounts to $150 (Military.com Benefits, 2010). The amount of cost shared amounts to 25% of the allowable charges. For most medical services, especially outpatient services, TRICARE standard provides 25% coverage of all medical services. Even for inpatient services, TRICARE standard provides 25% coverage for most services (Strobridge, 2005). Generally, TRICARE excludes a number of services and supplies which are considered medically or psychologically necessary for diagnoses or for treatment of the covered illnesses.  It also exclude all services and supplies, which may include inpatient institutional cost related to non-covered  conditions or those provided by providers who are not authorized.

There are many limitations of this coverage. It provides no primary care manager. Patients are also required to pay deductive and co-payment which means it does not provide coverage for all medical services. Patients are also required to pay the balance if the bill exceeds the allowable charge and when provide is non-participating which can add up to 15% additional (Military.com Benefits, 2010). In addition, non-availability statement may be required to civilian inpatient for any area that surrounds MTFs. Also, beneficiaries may be required to complete their own paperwork and therefore file own claims.

Question 2

There are options which are available for individuals who lose insurance coverage which I may include:

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is one of the many options that are available for individuals who lose their health insurance coverage.  It gives workers and their families  an individual to choose to continue with  a health benefits which are provided by their health plan for a short period of time which may be due to different circumstances like job loss, reduction in number of working hours, death, divorce, and many others (United States Department of Labor, 2010a).  Those who quality may be forced to pay entire premium up to 102 percent of cost plan.

Health Insurance Portability and Accountability Act (HIPAA) provides for facilitation of continued access to health insurance when one loses employer-sponsored coverage. Although access to HIPAA may be limited by stringent provision, it provides a temporary coverage for workers and retires after they lose their initial coverage. HIPAA has limited exclusions given for the pre-existing conditions and also provide credit against maximum condition exclusion (United States Department of Labor, 2010b).


Military.com Benefits, (2010). TRICARE Standard Overview. Retrieved May 7, 2010, from http://www.military.com/benefits/tricare/tricare-standard/tricare-standard-overview

Strobridge, S. (2005). Health  coverage at what price? Retrieved May 7, 2010, from http://www.moaa.org/todaysofficer/columnists/Strobridge/health_coverage.asp

United States Department of Labor, (2010a). COBRA. Retrieved May 7, 2010, from http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTML

United States Department of Labor, (2010b). Health Insurance Portability and Accountability Act. Retrieved May 7, 2010, from http://www.dol.gov/ebsa/newsroom/fshipaa.html

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