Alternative Healthcare Insurance Programs for Seniors

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). 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 resources in the most efficacious and cost-effective way. Throughout its implementation, the program will necessitate resources, which are usually scarce. As a result, the program manager has to guarantee an apt description, allocation, and timing for such resources. This section of the report elucidates an in-depth description of the resources required to implement your program.
1. Qualified Staff
Health Assistant Insurance Program will necessitate qualified and proficient staff to conduct everyday operations. Training will be offered to coordinators, staff, as well as volunteers. Every member of staff involved in the program's operations will be required to have an extensive comprehension of Medicare, senior health insurance challenges and programs and program management techniques, and repeatedly update their knowledge in these areas. The Health Assistant Insurance Program structure shall address staff training and updates, management, outreach, and education, in addition to a mechanism of communication and reporting among all Health Assistant Insurance Program staff. Regarding staff, Health Assistant Insurance Program will have:
i. A Director Programs who is responsible for overseeing and managing the everyday operations of the program
ii. Volunteers or staff who can be accessed by a senior individual with Medicare or is uninsured and facing coverage problems within all areas of the State
iii. Volunteers shall contribute  twenty hours of volunteering per month when in the state, providing services as needed
The following is a chart that explains how the staff will be structured in conducting the program:
The following are fundamental plans that will be implemented to enable the attraction, development, and retention of qualified personnel:
Health Assistant Insurance Program will provide members of staff and volunteers with adequate training and education on aspects of the implementation of the program. This not only provides a clear direction to heightened responsibility for personnel, but it also guarantees that staff is aware of their importance and value to the company. Furthermore, employees will be given prospects of furthering their education levels. This will be carried out in the shape of company training and workshops to facilitate personnel to acquire new sets of skills, compensation for training for external courses as well as advancing the education of personnel. This will not only entice highly qualified staff but also retain them. Secondly, employee packages and benefits are key contributing factors in guaranteeing that staff is continuously satisfied, engaged, and healthy. The employee perks offered will go over the basic coverage of healthcare and providing paid sick leave. There will also be flexible work schedules, and extensive paid leave policies.
2. Information Management Systems
The Information Management System will play a fundamental role in the everyday operation of the program. The system will guarantee that suitable data is gathered from different sources, processed, and sent further to other appropriate parties. Furthermore, the system will be beneficial in strategic planning, management control, operational control, as well as transaction processing. 
The staff of the program will capitalize on the system in the processing information of seniors and also coverage options and answer any sort of queries made by clients regarding the sort of coverage they qualify and also about specific information such as amounts of cover that can be paid. The system will also aid personnel through the provision of operational data for planning, scheduling, and control on a day to day operations and assist them further in decision-making at the operation level (Sakthivel, 2014).
3. Financial Resources
Financial resources will be required for funding the everyday operations of the program, payment of staff salaries and volunteer upkeep, maintenance of the system, and other needs. The project director will be required to develop a program budget for the apportioning of finances necessary to cater to and achieve project deliverables. This framework will enable the program director, project managers, and staff to cope with the budget needs in the project implementation process. The following is a budget for financial allocation of the various necessitated resources for the program:
4 Planning
4.1 Objectives
The goals of the program will be SMART, which implies that they will be specific, measurable, attainable, realistic, and timely. The objectives of the Health Insurance Assistant Program will include the following:
1.Health Insurance Assistant Program will provide seniors with education and significant insight into Medicare and Medicaid, prescription drug coverage and medical coverage plan comparisons, and also enrollments resulting in 75 percent increased enrollment by June 30, 2021.
2.Health Insurance Assistant Program will meet with senior citizens aged 65 years and above within our jurisdiction resulting in 4 out of 5 elderly individuals understanding how supplemental insurance options, for instance, the various insurance and coverage plans for retirees work in tandem with Medicare by June 30, 2021.
3.Communications and IT staff involved in the Health Insurance Assistant Program will evaluate and provide instantaneous and suitable referrals for seniors who qualify as coverage beneficiaries to state agencies, resulting in a 50 percent increase in the resolution of healthcare coverage problems.
4.By June 30, 2021, dependably and confidentially provide accurate, impartial, and all-inclusive information to all seniors. These seniors are involved with our program to select programs that they are most eligible for.
4.2 Ethical and Legal Considerations
This section will assess the different ethical and legal considerations about the program and its expected impact on healthcare reimbursement, policy, and governance. The section will also explain the expected issue-related outcomes and the plan to address them effectively.
First and foremost, the program will make certain that there is informed consent from the seniors included in the program's activities and operation. Ethics takes into account the code of mannerism that is considered right and, as a result, the program to be fully undertaken with fairness and justice by eradicating all prospective risks. This will include delineating in advance to the seniors, which data would be gathered, and how such data would be utilized regarding their care and coverage (Sanjari et al., 2014). 
Also, the program will make certain that all the senior participants in the program are completely informed about the various aspects of the program in a language that is understandable to them. All the participants were given proper clarifications comprising of the nature of the program's undertakings, the prospective role of every participant, the identity of the program's staff, the research objective and how the data will not be rendered to anybody else and also employed (Sanjari et al., 2014).
Another ethical consideration is the anonymity and confidentiality of senior participants in the program. That is, all of the s participants will be given the guarantee that their identity, medical status, and need will not be used for wrongful purposes. Also, elderly and senior individuals contacted will have free will to provide and also withhold as substantial information as they desire to the program (Saunders, Lewis and Thornhill, 2015). 
The program will also highly take into consideration the ethical issue of privacy. The senior individuals will be guaranteed that the information provided to the program would not be disclosed to other third parties, for instance, research labs. Also, there is the guarantee that their information will be employed objectively to facilitate their access to medical coverage and the varying benefits that they qualify for (Saunders, Lewis and Thornhill, 2015).
Inclusion in the program will be completely voluntary and will be centered on informed consent (Jahn, 2011). Seniors will be given insight into their option to participate in the program's activities and also the liberty to pull out from the research at any given time they want devoid of any form of repercussions. The principle of autonomy indicates that there is a permission of the self that is free from controlling influences of others, therefore permitting liberty and also from personal confines that preclude meaningful choice, such as inadequate understanding (Jahn, 2011). The ethical principle of beneficence will be taken into consideration. This alludes to acting for the benefit of others. Specifically, the program will be entirely formed and operate for the benefit of seniors who are either uninsured or struggling with coverage to obtain the benefits that they qualify for (Jahn, 2011).
There are also legal considerations that the program will have to address. First, the program will have to ensure that it is in line with the Health Insurance Portability and
Accountability Act (HIPAA). This federal law is put in place to ensure that entities can capitalize on medical records and information objectively and in every way that pertains to their health care. In this regard, the program will guarantee medical privacy by making certain that the information provided by the seniors will not be utilized in ways that are unrelated to their health care. Also, in case of sharing information, the program will have to, first of all, obtain permission before sharing such information with other third parties. Moreover, the program will make certain that it takes sensible steps to meet the senior's request for confidentiality (Pacer Center, 2020). Also, the program will have to ensure that it has obtained any legal permits and sanctions as necessitated by state laws and also federal laws.
4.3 Resource Contribution
First, people are one of the fundamental determining factors for the success of a program or organization. The program is dependent on staff to carry out everyday tasks, resolving significant challenges, and providing exceptional customer services. To achieve this, the staff has to be qualified. As a resource, qualified staff will make a significant contribution to the success of the Health Insurance Assistant Program. Specifically, the qualified staff will be pivotal in ensuring that the pertinent and best information is available for seniors in making insightful healthcare decisions regarding their eligibility for medical coverage. The staff will facilitate the planning, collecting, analyzing, and conveying information from senior citizens. Secondly, the information management system will make a meaningful contribution as a resource to the program regarding enabling data generation, assembling, analysis and combination, and communication and usage. Specifically, the system will be pivotal for gathering the data from the senior citizens, analyzing such data and guaranteeing their general quality, pertinence, and appropriateness and converting such data and information into highly informed health-associated decision-making. Lastly, financial resources will make a pivotal contribution to the financing of everyday activities. Also, the finances will be essential in procuring the different items necessitated in the program, such as computers, inventory, stationery, desks, and several others.
4.4 Timeline
The workforce will work with every individual directly to create a profile and scan through all benefits that they would qualify for. The program will take approximately 12-15 months to implement
5 Implementation
5.1 Activities
The following is a detailed explanation of the activities leading to accomplishing the objectives acknowledged, including the justification behind their selection, their arrangement, and the thinking behind why these methods may work.
First of all, the program will recruit staff, personnel, and volunteers with extensive insight on coverage, needs, and challenges faced by seniors and the elderly in gaining care and the aspects of Medicare and Medicaid. It is imperative to note that Medicare is the fundamental medical coverage provider for numerous individuals who are aged 65 years and beyond and those living with disabilities.
For instance, the personnel will need to have insight and knowledge on aspects such as the eligibility for Medicare, which is not determined or influenced by the individual's income. There is also Medicaid, which is intended for individuals with confined levels of income and elderly persons lacking access to other resources (Hohmann et al., 2018). Moreover, the personnel will be trained on how to communicate with the seniors in a language and conduct that enables them to comprehend their needs and how they can benefit. The justification for this is because proficient personnel will guarantee the success and effectiveness of the program in its objectives and also sustainability.
Assisting seniors as beneficiaries in coverage plan selection necessitates the personnel to know about Medicare and confidence in using the tools included in the program, as well as the ability to interpret the results of the tool. For the reason that didactic and experiential learning can have a positive impact on personnel's' self-assurance and willingness to provide services, there is a need to create a service-learning program to prepare future personnel and volunteers to effectively assist senior individuals (Cutler et al., 2008).
Secondly, the Health Insurance Assistant Program will be implemented through one-on-one, personalized assistance, and assist Medicare beneficiaries in choosing the most suitable and economic plan. The workforce will work directly with every individual to create a profile and scan through all benefits that they would qualify for (Hohmann et al., 2018). Specifically, our program will work in tandem with community health care centers and also pharmacists. These facilities are prospectively well suited to facilitate the provision of one-on-one assistance to senior individuals within the community.
Without a doubt, the annexation of pharmacists in the care of coverage senior beneficiaries is financially favorable from both beneficiaries' and plan sponsors' standpoints. Owing to the suitable hours of operation in addition to a substantially high level of trust in the line of work, numerous seniors may choose to seek help from pharmacists in the course of Medicare open enrollment to make an ascertainment into which plan is most suitable. Nonetheless, it has been ascertained that the majority of these facilities have been unable to provide such information precisely. Therefore, with the Health Insurance Assistant Program incorporating these facilities, it will be possible to fill this gap and directly meet the needs of the senior individuals (Stebbins et al., 2009).
Health Insurance Assistant Program will, in collaboration with national, state, and local partners, engage in seniors' coverage outreach events in addition to public education training and presentations in an endeavor to increase awareness and knowledge. The program will evaluate, plan, and partake in outreach events. These events will comprise elderly interviews to inform seniors regarding the accessible coverage information channels, in addition to overall, accurate information on health benefits, consumer human rights, and protections. 
Also, part of the program's implementation plan will include guaranteeing that seniors with Medicare, their relatives, and caregivers can carry out informed health coverage decisions and comprehend associated rights and protections. Moreover, Health Insurance Assistant Program will institute and sustain partnerships with suitable federal and state agencies. This is done to help with health insurance issues, and to resolve and direct the interchange of health insurance information between Health Insurance Assistant Program staff and pertinent State and Federal Government workforce. What is more, to guarantee that progressively more senior individuals obtain the assistance required, Health Insurance Assistant Program will share pertinent and important information regarding senior coverage care problems and grievances to suitable State and Federal Government departments.
5.2 Sequence
The sequence of the activities to be implemented for achieving the set out objectives include:
6 Evaluation Methodologies
6.1 Methods 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.