Medicare Embodies: A Case Study

Medicare is the nation’s largest health insurance program. Generally, you are eligible for Medicare if you or your spouse worked for at least ten years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. Medicare-covered services include hospital insurance, inpatient hospital care, skilled nursing facility care, home health care, hospice care, and medical insurance (Medicare U.S.) With such an encompassing effect on the health insurance field, Medicare provides a haven for older individuals, and end-stage renal disease (ESRD) patients who require the best medical care for whatever possible reason. The only problem with this scenario is

When Medicare was first established, Medicare adopted the payment methods of Blue Cross Blue Shield which meant that the program was paid hospitals on the basis of their own costs and physicians were being reimbursed by the fees that they charged which caused hospitals and physicians to provide care without boundaries (Anderson et al., 2015). This method caused Medicare to dissipate the budget that was established for beneficiaries to utilize. Now, with the ACA being implemented, Medicare had done an overhaul of payment reimbursement. Medicare is now moving toward a volume to value payment initiative that links payment to patient outcomes, experience of care, while giving providers an incentive to limit spending

Health care has become a target for unscrupulous individuals. Both private industry and government are employing a variety of tools to combat fraud and abuse. Since 1992, we have made tremendous progress in protecting the fiscal integrity of the Medicare program. An example is the HCFA initiated partnership with the enforcement agencies targeting fraud and abuse in those five states that account for nearly 40 percent of all Medicare and Medicaid beneficiaries. This two-year project, Operation Restore Trust, encompassed a wide range of projects aimed at eliminating fraud schemes and identifying vulnerabilities in the Medicare programs. The reforms enacted in the Balanced Budget Act of 1997 and the Health Insurance Portability and Accountability Act of 1996 provide significant new tools to further assist us. But I think we all know that equally tremendous challenges he ahead. Our goal is to ensure that the Medicare and Medicaid programs have the necessary arsenal to combat fraud and

Medicare, which was first enacted by Congress in 1965, is a popular, yet failing, program because of a rapidly increasing population of retirees and their increasing costs; despite program’s flaws, Medicare is difficult to change because of the political influence of the elderly, who approve of the benefits they receive from the program. Medicare provides health benefits to citizens who are eligible for social security benefits(Fiorina, Peterson, Johnson & Mayer 2009). The program is embraced by the public, but Medicare’s increasing cost makes it difficult to sustain. Due to its popularity, the program is also very difficult to change, but without limitations the program will continue to decline in the future.

Person eligible for Medicare include individuals ages sixty-five and over, those with disabilities, and those with end-stage renal disease (Hammaker, 2011). here are three basic entitlement categories: persons 65 years of age or over who are eligible for retirement under Social Security or the railroad retirement system, persons under 65 years of age who have been entitled for at least 2 years to disability benefits under Social Security or the railroad retirement system, and persons with ESRD who do not otherwise meet the age or disability requirements. The latter two groups together are known as the "under 65" enrollees (Petrie, 1992).

Medicare is a social insurance program that is sponsored by the government (1). This was originally made for the long term care for the elderly people that needed health insurance (2). There are four different parts that are provided to the people that are eligible for Medicare. Part A helps pay for the hospitals. As Part B pays for all medical reasons; such as, physician visits, outpatient services, and the need for medical equipment. Part C, for example, deals with the care of people with diabetes, and Part D is to provide people with prescription drugs (1).

As a whole, the authors of the articles shed light to the inequality of medical care among Medicare recipients depending on the region. Not only inequality, but even with those individuals that received large care, there was no notable difference of their overall health with those that spent least. In other words, the amount spent on Medicare patients has no correlation with better health or higher quality of life. On the contrary, Medicare patients that received the most benefits were deemed to have life-threatening conditions. Although the uncovered such information, they suggested new approaches to improve the Medicare program, focusing on a population-based approach and accountability for all hospitals and

think that Medicare is one of the greatest and most important programs for US society that was ever created. Followed by National Defense and Social Security program, Medicare is the third largest program in the Federal budget. In 2013 cost of Medicare was $492 billion which is 14 percent of total federal spending. According official information by the end of 2014 49,435,610 people received health coverage through Medicare program.

While managed care saves money, not all states were quick to adopt it, and the extent to which they did varied widely across states. Why states chose to adopt the programs they do has been the topic of much research, the most groundbreaking being by Walker (1969) and Gray (1973). They claim that each region of the United States has within it one or two states that are more likely to adopt new programs before others. Managed care adoption began in earnest in 1993. To use 1993 as a starting point for examining managed care adoption would confuse innovativeness with those factors which genuinely may make managed care a more appropriate policy choice. Hence, this paper focuses on the year 1996.

Medicare is an example of a socialism insurance coverage in the United States. It was created back in 1965 when President Lyndon B. Johnson signed the law into place for the system known as “Original Medicare (CMS Program History, cms.gov).” Original Medicare consists of hospital coverage (Part A) and physician/outpatient coverage (Part B). These benefits have evolved through time with the expansion in eligibility in 1972. The largest change to Medicare occurred in 2003 with the passing of the Medicare Prescription Drug Improvement and Modernization Act. The act created two new parts to Medicare. Part D is the prescription drug benefit to Medicare, a benefit lacking in traditional Medicare. Part C is a combination of Parts A & B but it is administered by a Health Maintenance Organization that contracts with Medicare beneficiaries. Part C may offer additional services

There are so many Incentive Programs that provide financial incentives for the use of certified EHR technology to improve patient and by taking part the Center can receive incentive payments for certain Medicaid health care and can receive up to a maximum of $63,750 over six years participation. Although to qualify we must have a minimum 30% of Medicaid patient volume and a practice predominantly in a Federally Qualified Health Center and have a minimum 30% patient volume attributable to needy individuals.

Medicaid is a cooperative program administered by federal and provincial government that insures individuals with chronic illness or disabilities who could not have had the means to obtain insurance elsewhere. However, Medicaid’s ability to run efficiently has started to be questioned due to growing budget pressure. This program is need of improvement, so it can benefit both the people and the country. Medicare faces its challenges too, as the population of elderly grows, so does the cost of the program. The coverage of Medicare is also questionable. The government covers about 60% of the medical expenses under Medicare, however 15% of Medicare recipients are so indigent that they would be entitled to Medicaid. Money is also the problem for

Medicare Part D was created under the Medicare Prescription Drug, Improvement and Modernization Act of 2003. (Medicare Part D, 2011). It is also known as the prescription Drug Plan. This plan was created to help cover cost of prescription drugs, and people who have the original Medicare or Medicare Advantage are eligible to enroll (Medicare Part D, 2011). Prescription drug coverage is only offered through HMOs, PPOs, and PFFSs and by some private companies who contract with Medicare through individual plans (Medicare Part D, 2011). Private companies are allowed to create their own customized benefit plan as long as the plan is as good as the plan outlined in the 2003 Medicare Act (Medicare Part D, 2011).

Raising the Medicare qualification age is a smart thought, given the monetary allowance issues we confront and the way that Americans are living longer. In any case, it must be done painstakingly, to verify that more seasoned laborers still have wellbeing protection. Both Medicare and Social Security were proposed for resigned Americans. So it would bode well to set the ordinary qualification age of every project at the age where we have chosen as a country that retirement ordinarily starts. What's more, since working Americans create the cash to pay advantages, it's likewise essential for the qualification age to be set where the quantity of years Americans work is sufficient to pay retirement advantages. With Americans living longer, we have

“Medicare-for-all” is piece of legislation proposed by Vermont Senator Bernie Sanders that advocates for a single-payer healthcare system and universal coverage for all in the United States (Keith & Jost, 2017). The bill details a national health insurance plan, funded by a government trust, that would cover all services from hospital stays to primary care visits, thus eliminating high out-of-pocket costs, copayments, and deductibles. Comprehensive coverage under Medicare-for-all would also include treatment for substance abuse, mental health counseling and resources, reproductive and maternity services, and even abortion (Keith & Jost, 2017).