1. State Licensure Requirements
Medicare Advantage Plan is described has a type or branch of Medicare health insurance program, which covers healthcare expenses for the disabled, poor or less fortunate individuals, and the older population in the society (Brown et al, 2011) .This health insurance program is specifically provided by private health insurance companies under licensure from the federal government health insurance program or Medicare.
Before an organization is allowed to become a Medicare Advantage plan member, such an organization or institution is required by law to comply with various state licensure requirements and guidelines (Budrys, 2011). These requirements includes capacity to have been in operation or in health insurance business for at least one year, the organization to be dully registered in the state it seeks registration, such organization to be committed to solely deal with Medicare Advantage plan health packages only, and at least 5,000 individuals (or 1,500 individuals if the organization is a PSO) to be registered by the organization for purposes of health benefits. Organizations seeking licensure are also required by law to have management experts with prior experience of providing health care services, to possess financial capacity to bear eminent risks under MA contract, and finally to be in position to establish effective enrollment and marketing process that will allow it to meet the required enrollment (Niles, 2010).
Regardless of the strict state licensure requirements, exceptions to these requirements is provided when applications are rejected due to standards and material protocols such as late applications ,when organizations engage in other insurance products rather that MA plan, and when licensure is denied due elements of solvency (Gold, 2008). Special consideration is provided to these entities when such organizations propose to introduce MA plan package in areas or regions covered by fewer MA plans, when the organization plans to provide more MA plan packages than its previously offered, and when such organizations undergoes organizational changes such mergers and acquisitions that portrays new business entity (Brown et al, 2011)
2. Military Health System & Tricare
The Military Health System is categorized has a venture of the United States Department of Defense, which concentrates on provision of health care services to Active Duty and retired military personnel and their immediate families (Gold, 2008). The main objective of this venture was specifically to promote and maintain health of military personnel in order for them to serve their country effectively and diligently. The major strengths to the survival of the military health system relates to the fact that it’s an initiative of United States Department of Defense, and it solely concentrates on welfare of both active and retired military personnel’s and their families. Another notable strength of this program relates to the fact that it’s financed and managed directly by the federal government, hence there is minimal interference from external forces. Its major threat results from increased service duties that increases the cost of services and from elements of increased dissatisfaction in regard to care provided among beneficiaries (Haley & Kenney, 2012).
Tricare on its part it’s a health program of the Military Health System, which provides health insurance coverage to cover medical expenses for military personnel and their dependents. TRICARE Health Plans was established as a replacement to the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), a health care program formulated by the DOD to provide civilian like health benefits to the disciplined military forces (Budrys, 2011). Its main objective just like the original CHAMPUS was specifically to provide military personnel’s with better and easier access to healthcare services. The Tricare program is subdivided into 3 unique categories namely TRICARE Prime, Standard, and Extra, which covers various medical requirements for the military personnel.
Regrettably, Tricare has undergone various changes and turmoil since its inception and most of its problems are related to the nature and type of care provided. The program greatest threat relates to the ever increasing specialized medical needs which the program cannot afford or effectively provide to the military personnel. Other notable threat includes lack of effective leadership and management and organizational strategies at the helm of the program (Haley & Kenney, 2012).These threats can be avoided by initiating mechanisms that completely overhaul the current system in regard to leadership and management, organization goals and objective, and diversifying the type of care being provided.
Brown, J. et al (2011) ""How does Risk Selection Respond to Risk Adjustment? Evidence from the Medicare Advantage Program."" NBER Working Paper No. 16977, April 2011. Retrieved from < http://www.nber.org/papers/w16977 >
Budrys, G. (2011). Our Unsystematic Health Care System. Lanham: Rowman & Littlefield.
Gold, M. (2008). "Medicare Advantage in 2008," The Kaiser Family Foundation. Retrived from < http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7775.pdf >
Haley, J. & Kenney, G. (2012). "Uninsured Veterans and Family Members: Who Are They and Where Do They Live?". Urban Institute. Retrived from <www.rwjf.org/files/research/74428.quickstrike.veterans.052412.pdf>
Niles, N. J. (2010). Basics of the U.S. Health Care System. Burlington: Jones & Bartlett Learning.