Medicare Modernization Act Research Paper

Whether you love it, hate it, support it, or detest it The Affordable Care Act as it stands, has been making waves across both news headlines and the medical community alike. For the most part, the focus of the act has been placed on the impact it will have on the consumer or the patient. However, the pharmaceutical division of the medical community is among the groups that are most impacted by the Affordable Care Act. In particular, retail pharmacies are feeling the effects of the act via the reimbursements and provisions surrounding the reimbursement policies that have been altered with the passing of the Affordable Care Act. Reimbursements and the provisions implemented upon retail pharmacies by the Affordable Care Act could prove to be detrimental towards the success and profits gained by private retail pharmacies.

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

The passage of the Medicare Drug Price Negotiation Act will also inadvertently increase access to many types of medications for individuals who qualify for Medicare Part D. There is a clause within the bill that would establish rebates to be paid by pharmaceutical companies for low-income beneficiaries. These rebates, in addition to lowered costs, would considerably lessen the financial burden placed on low-income beneficiaries. This will allow more individuals greater access to expensive medications. As an example, each year, financial reasons hinder about 16% of diabetic Part D beneficiaries from filling at least one of their prescriptions (Williams, Steers, Ettner, Mangione, & Duru, 2013). This increase in access will help mitigate the occurrence of cost-related nonadherence to prescription medications, and other such consequences

The essential target of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was to furnish seniors in the United States with moderate scope for their physician endorsed solutions through the new Medicare Part D professionally prescribed medication advantage. After the MMA was implemented—however before Part D was actualized—there was a disagreement about the cost of the program. In March 2004, the Medicare Chief Actuary affirmed before the House Ways and Means Committee of United States Congress that he was requested by the (Centers for Medicare and Medicaid Services) CMS Administrator to smother his assessments of the ten-year cost of the program, which were considerably more noteworthy than unique Congressional Budget

The PPACA also took steps to reform the Medicare System. Medicaid will be broadened to offer coverage to those families making up to 133% of the poverty line (Jacobson, 2011). It also phases out the Medicaid “doughnut hole” in the next few years. The “doughnut hole” is the gap in prescription drug coverage that the Medicare Part D Prescription Drug Program had in place. Seniors had to pay 100% of the costs of prescription drugs that were over $2250 but less than $4550 in annual costs. Under the new provisions these costs would be covered by 2019 (Jacobson, 2011).

It is important that we all understand the basics of the Medicare and Medicaid programs as we will all eventually come of age where it is necessary to seek their assistance. The purpose of this paper is to give a brief history of how the program came about, the various plans for each program, issues that affect cost and access to the programs, how the political arena is affected and finally a conclusion with final thoughts on the total information.

Also referred to as a Medigap plan, Medicare supplemental insurance policies are important for most people who are covered under Medicare. When you turn 65, you can apply for coverage under Medicare, but this insurance will not cover all of your medical expenses. This is the purpose of purchasing additional health insurance. However, there are a few things to understand about Medicare supplemental health insurance. The following are three of them.

Medicare is very important. It provides much needed support for the elderly and disabled. Medicare’s importance only continues to increase. In order to keep Medicare running, the program is in need of reform. There are a few ways this can be done. I believe the best way to stabilize the financial crisis of Medicare is to completely reform the program into a defined contribution program.

Hospitals:- Medicare covers a public patient for free treatment in a public hospital, by a doctor recomended by the hospital. You do not have free will to choose your own doctor or choose the day that you undergo examinations, treatment, or surgery.

The Medicare Trust Fund was established in 1983. It was a mass shift and strategy in social and Medicare. In the past, social security and Medicare had a “pay as you go” system. That means workers were compensating current retirees and retirees benefits. The founded system was unsustainable for baby boom generation. Moreover, Medicare Fund is by law to request to buy U.S Treasury Bonds. It has one only asset to fund the government, so if it collects taxes of the assess of expensive it needs, it has essentially have to load the money to itself. Throughout the history of 1980’s and 1990s was a federal deficit that was mass by large parts of social security and Medicare trust fund purchases of those bonds. The Medicare is a traditional trust

Medicare law permits installment just for administrations or supplies that are viewed as sensible and meaningful for the expressed finding. Medicare won't cover systems regarded to be a trial in nature. There are cases in which the supplier verifies that medications or administrations are ultimately advocated, and such treatment choices are then disclosed to the patient, who must pay the full cost of the non-secured system.

Medicare/Medicaid was signed into law in 1965 to help prevent elderly retirees from going bankrupt (Centers for Medicare Medicaid Services, 2013). The bill consisted of three parts: Part A would guarantee that hospitals stays would be paid for. Part B would cover outpatient hospital care with a premium and the third part was Medicaid. Medicaid gave funds to poor individuals who could not afford medication. Since it was implemented no major, changes have been made to the bill with the exception of a fourth part being added known as Part D. It replaced Medicaid paying for medication (Centers for Medicare Medicaid Services, 2013). A significant development in Medicare came with Medicare plus choice, which allows an individual to contract alternative medical institutions. It has allowed elderly Americans to receive the healthcare they need, but it is breaking the nation as more and more people become eligible for it (Centers for Medicare Medicaid Services, 2013). Senior citizens dominate a lot of health

Medicare was created in 1965 to offer assistance to Americans 65 years of age or older or those who are on Social Security disability. Prior to this, most elderly Americans did not have insurance as it was not available to them or they could not afford it. Today, less than 1% of elderly Americans are without insurance or access to medical treatments. Medicare accounts for 20% of healthcare expenditures, one-eighth of the Federal Budget and more than 3% of the nation’s Gross Domestic Product.1

The article I selected discusses the impact that Medicare Advantage Plans have had over Medicare Supplement Plans, or Medigaps, with a company known as Mutual of Omaha. Mutual of Omaha, a company known as a Medicare Supplement provider giant, has announced its entry into the Medicare Advantage market. For many years, the company has helped cover the costs of healthcare not covered by traditional Medicare alone by providing Medicare Supplement plans. Medicare recipients have used these supplements to help compensate the costs of these non-covered benefits. Brad Buechler, a Mutual executive vice president, explains the reason the company had to change its dynamics is because, “Medicare Supplement enrollment is declining and Medicare Advantage

Medicare was enacted in 1965 to provide health insurance for patients 65 and older. Since the 1970’s, Medicare has included private plans.1 This portion of Medicare has had different names: Medicare Part C, then Medicare + Choice, then Medicare Advantage (MA).2 Private plans in Medicare fail to reduce cost, worsen access and have variable influence on the quality of care that is provided to enrollees as compared to traditional fee-for-service Medicare (FFS Medicare). Expansion of the role of private plans in the Medicare environment can prove to be toxic. In the same vein, premium support for private plans would undermine our existing institution. Other solutions should be sought to improve care and decrease spending in Medicare.