Medicare Part A Case Study

Over the last 8 years especially, the national spotlight has been focused on government programs, specifically Medicare and Medicaid, whether these opinions be positive or negative. Although many people believe that these governmental acts only include negative aspects, this is in fact wrong, as there are many positives. Medicare, the commonly known health insurance program for people 65 and older, has positively contributed to the American society for the past 50 years. Medicare has helped elders financially , increased the quality of care we give to elders, and provided more jobs throughout its existence.

Medicare is one of the major financing sources for healthcare since 1965. Hospital Insurance or Medicare Part A is funded 1.45% from employee payroll tax and 1.45% from employer on all revenue. Self-employed individuals pay 2.9% of income. The government support nearly 75% of Medicare Part B and the other 25% is paid by individual’s monthly premiums. Medicare Part B individuals will be covered 100% once their $147 deductible is met. (Shi, L., & Singh, D. A., 2015)

Part A is predominantly financed through taxes paid by employees and employers (Facts, 2015). There is a 2.9% tax on earnings, and taxes account for 87% of Part A revenue. The taxes are deposited into the Hospital Insurance Trust Fund (Medicare, 2014). Additionally, the article (2015) states that employers and employees pay a payroll tax of 1.45% each, while higher-income taxpayers pay a higher payroll tax of 2.35% on earnings. Part B is funded by general revenue and premiums paid by beneficiaries. Medicare pays premiums for Part B on the behalf of beneficiaries who qualify for Medicaid based on their low incomes and assets (Medicare, 2014). Alternatively, beneficiaries with higher incomes pay a higher monthly premium based on their incomes (Medicare, 2014). According to data collected in 2014 by the Kaiser Family Foundation (2014), these premiums can range from $146.90 to $335.70 per month. The article (2014) states that the income thresholds for the

Part A covers hospitalization, emergency hospitalization, subacute care, home health, and end of life care depending on the situation. Part B covers Doctors’ visits, and covers subacute, end of life, and in home care that Part A will not cover if the patient qualifies. While part C covers medications and needed medical equipment (Center for Medicare and Medicaid Services, 2014). What Medicaid pays for depends on what state you live in, and what your specific situation is. Universally Medicaid covers hospitalization, day procedures, doctors’ visits, nursing facilities, home care, child health check, nurse practitioners, and transportation to doctors’ visits (Medicaid.gov, n.d). Medicaid offers different services in each state, but the aforementioned are the mandatory areas of coverage for every state. Medicare is aimed at helping the older population, while Medicaid is aimed at people in every stage of life. But who exactly is covered under which

Medicare is a health insurance program purposely created for people over sixty five (65) years of age. However the service is open to people with certain disabilities or permanent kidney failures. The process of choosing the right Medicare involves having to weigh different plans on account of benefits of their cover. Different types of Medicare plans are important in: Inpatient hospital care, outpatient services, doctor visits, home health care, prescription drugs, and care in a skilled nursing facility among others. In addition, the program covers the cost of health care but does not cover all medical expenses including cost of long term care. If one ought to choose an original Medicare coverage, one may buy a Medicare supplement policy from a private insurance company to aid in coverage of costs that are not supported by Medicare. Most of these Medicare expenses are covered by a part of the pay role offered to workers by their employer. This paper covers different Medicare plans; A, B, C, D and their influence towards my decision on the best preferred option.

Fifty years ago, Lyndon B. Johnson signed the Medicare program into law. “It has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses.” (Hamel, Blumenthal, Davis, & Guterman, 2015, p. 479). With the encouragement of George W. Bush, congress passed the Medicare Modernization Act of 2003 (MMA). The MMA extended Medicare to include prescription-drug coverage, known as Medicare Part D. In 2013, Medicare covered the health care expenses for 52.3 million Americans, costing $583 billon. Originally, Medicare had difficulty controlling costs; physicians and hospitals were

The majority of Medicare issues result from structural complexity and fragmentation, resulting in confusion for beneficiaries and health care providers alike. Most insured nonelderly Americans enroll in single health plans that pay for all covered services, including inpatient, physician, pharmaceutical, and rehabilitation, with a single system of premiums, copays and deductibles (Blumenthal et al. 486). In contrast, Medicare beneficiaries must deal with a variety of different plans to cover these same expenses, each

“Medicaid covers basic health care costs such as visits to the doctor and hospital stays, but can also cover things like the costs of eyeglasses… Medicare covers hospital and post-hospital facility charges, as well as home health care, doctor fees and lab costs, outpatient care, and prescription drugs” (Reuters). Medicaid covers simple costs, meanwhile Medicare pays for more expensive cost such as doctor bills. With Medicare there are four different parts: Part A, B, C, and D; however, each part has different coverages. Medicaid may charge patients small service fees and with Medicare there is a yearly deductible for all plans; with these different plans they copay lengthy time in the hospital which would be Part A, Part B covers 20 to 35% of medical bills, plus monthly premiums, and Part D has coverage gaps that will not cover total drug costs over $2,840, but will once total drug costs reach $4,550 (Reuters). Medicaid patients usually pay nothing, but a small co-payment is sometimes required. With Medicare, Medicaid will often pay for what Medicare will not pay for. For example, deductibles, premiums, and sometimes up to 20% off medical costs. For Medicare, payment charges may vary depending on what plan the patient has. With saying this, what services they cover and the cost are a big impact on which insurance the user would most

Medicare, as nationwide social insurance passed into law as title XVII of the Social Security Act of 1965, currently using about 40 private insurance companies across the United States. The primarily purpose of Medicare was to provide financial support to elderly age sixty-five and older or younger people with a permanent disabilities. There are four different parts of Medicare plans to select from: “Part A provides hospital and skilled nursing coverage’s through Hospital Insurance Trust Funds. Part B covers physician services, ambulatory surgical services, and other miscellaneous services paid by Medicare beneficiaries. Part C is managed care coverage offered by private insurance companies. It can be selected in lieu of Part A and B). Medicare Part D covers

Medicare currently pays for many preventive services that can detect health problems early when they’re easier to treat, give better access to claims and personal health information, and allow for savings on brand-name and generic when coverage gaps are met. The actual benefits of Medicare will not be changing. There will however be a new plan that is key to the Affordable Care Act that will take place in 2014. This plan is the Health Insurance Marketplace that allows individuals, families, and employees of small businesses to get health insurance. (Services, 2013 ) The Marketplace offers insurance plans through private companies that will provide essential health benefits regardless of gender, preexisting conditions, or preventative

Medicare is America’s largest health insurance program for the men and women over the age of 65 or with certain disabilities. For many Americans, this a huge part of how they can afford medications, doctor visits and other medical expenses. In recent years the number of Medicare enrollees has doubled (NASI, 2015). The “Baby Boomers”, people born from 1946-1965, is the largest generation within America with roughly 75 million Americans. This generation of Americans are all turning 65 around the same time and enrolling into this medical program. With the amount of new enrollees the total spending for Medicare will rise from 3.6% of the nations GDP to 5.1% by 2030, when the youngest of the baby boomer generation will be 65 (NASI, 2015). Even

Medicare offers health insurance to individuals over the age of 65, people with certain disabilities, persons with Lou Gehrig’s disease, and individuals with severe kidney disease. Benefits are available regardless of an individual’s income. Medicare is administered exclusively by the federal government. Medicare stipulates one must be a U.S. citizen or legal resident for five years; and that he or she has contributed to FICA payroll tax for a minimum of 10 years. Medicare has a number of parts (A, B, C, and D); that pay for specific types of health care costs. Following a three day stay in a hospital for skilled care, nursing home care is covered only for 100 days by Medicare. Copays and deductibles (sometimes quite substantial) are paid by beneficiaries of this program.

Medicare is broken down into different parts that those who are insured can choose what program is best for them. There are four different parts to the Medicare health care system. There is the Medicare Part A, this part covers hospital insurance, meaning stays in the hospital, care

When Medicare first went into effect the monthly premium for Part B, medical insurance, was three dollars. As it stands today in year 2010, Part A, hospital premium, is $254 to $461 per month. Part B, the medical insurance portion, is $96.40 for those individuals whose income does not exceed a certain amount. There are also multiple co-pays and carve-outs, which further increase the cost to the patient. The ceiling restrictions put on various costs, such as the daily allotment for hospital stays and skilled nursing facilities, often do not fully cover the patient’s expenses.

A part of the problem of cost was the establishment of “free” healthcare for those eligible for Medicare and Medicaid, between 1965 and 1971 where there was no limitation on benefits. The cost of healthcare increased from 39 billion in 1965 to 75 billion in 1971. Providers had no concern for the cost of their care seeing that SSA recipients had no limits