Medicare Problem Essay

The types of managed care are differentiated by definition, operation, structure, and information needs. `HMOs were the most common type of MCO until commercial insurance companies developed PPOs to compete with HMOs' (Douglas, 2003, p.331). `HMOs are business entities that either arrange for or provide health services to an enrolled population after prepayment of a fixed sum of money, called a premium' (Peden, 1998, p.78). There are three characteristics that an HMO must have. The first is a health care financing and delivery system that provides services for members in a particular geographic area. Second, is ensured access to a complete range of health care services, health maintenance, treatment, and routine checkups. Last, health care must be obtained from voluntary personnel that participate in the HMO. The five HMO models related to the participating physicians are the Staff

Medicare is a federally governed insurance program, primarily serving Americans over the age of 65, younger disabled meeting specific disability criteria, and dialysis

I believe the United States has an economic dilemma when it comes to social security and Medicare. As our textbook states, social security is drastically underfunded. It also says that Medicare is underfunded as well. I have listened to people who talk about how there will not be enough money in social security after the millennial generation. If this is true, then my generation and other generations after me will be in a terrible situation when they can retire. Medicare, a government, insured health insurance program, is also a matter of concern. Since the Medicare fund is underfunded at a high level, people who would need the help of their Medicare plan could potentially backfire. If the funding for Medicare does not reach a level where you would not have to worry about the quality of the care, then potential health risks could become much worse without adequate resources used to treat and prevent them.

Contrary to this, anecdotal reports stated that other clinicians sometimes spend more times in checking and treating patients with severe illnesses or who are in critical conditions, which made the physicians care for a greater number of patients with lower acuity. Whenever a physician and clinician bill for the same service, it is very difficult to tell if the physician saw a more complex patient. Due to these uncertainties in comparing their services, the Commission is reluctant in altering the payment differential. From that discussion, every provider must be familiar with some fundamentals about Medicare. First and foremost, there is Medicare Part A, which actually covers skilled nursing home, hospital, and home health charges; and then there is Medicare Part B, which then envelops most outpatient services, the care that patients in particular obtain from a doctor’s office (Fishman, 2002).

Critics believe that the present functioning of managed-care is degenerative to health care. Managed-care firms control costs by requiring patients to use a “network” of approved doctors and hospitals, and by reviewing the actions of doctors. Patients have to pay more to visit a doctor who does not participate in the “network.” Managed-care firms second-guess doctors, considering only the costs. Patients are often prevented from visiting specialists to reduce costs. A managed-care company might insist that its doctors prescribe inexpensive generic drugs instead of commercial products. Many patients must, also, receive the insurer’s approval before undergoing treatments or operations. HMOs have been criticized for refusing to pay when a patient goes

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

Collectively, the Department of Health and Human Services and the Department of Justice work to reduce healthcare fraud and investigate dishonest providers and suppliers. The Health Care Fraud Prevention and Enforcement Action Team recouped almost 3 billion in fraud, this year alone. Also, aggressive strategies exist to eliminate Medicare prescription fraud. Patients abusing or selling painkillers received by visiting several doctors and obtaining multiple prescriptions costs Medicare millions annually. Fraud affects everyone, preventing it requires government officials and citizens diligently working together.

Medicare and Medicaid are two of the United States largest broken systems, which must sustain themselves in order to provide care to their beneficiaries. Both Medicare and Medicaid are funding by a joint effort between the federal government and the local state government. If and when these governments choose to cut funding or reduce spending, Medicare and Medicaid take the biggest hit. Most people see these two benefits as one in the same, two benefits the government takes out of their pay check to help fund health care. While the government does deduct a sum from paychecks everywhere, Medicare and Medicaid are very two very different programs.

Medicaid and Medicare are two different government programs. Both programs were created in 1965 to help older and low-income families be able to buy their own private health insurance. These programs were part of President Lyndon Johnson’s “Great Society” plan, a commitment to helping meet the needs of individual health care. They are social insurance programs, which allow the financial load of patient’s illnesses to be shared by other healthy, sick, wealthy, and lower income individuals and families.

In discussion with two families, the pros and cons of Medicare are discussed. Melvin and Barbara Coats are above retirement age and until recently were both still working. Edward and Betty Florence are below retirement age, but Edward is disabled and hasn’t worked since 2007.

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).

U.S. health care reform is currently one of the most heavily discussed topics in health discourse and politics. After former President Clinton’s failed attempt at health care reform in the mid-1990s, the Bush administration showed no serious efforts at achieving universal health coverage for the millions of uninsured Americans. With Barack Obama as the current U.S. President, health care reform is once again a top priority. President Obama has made a promise to “provide affordable, comprehensive, and portable health coverage for all Americans…” by the end of his first term (Barackobama.com). The heated debate between the two major political parties over health care reform revolves around how to pay for it and more importantly, whether it

Due to the upcoming presidential election, the two major political parties, and their candidates, have been focusing on the primary problems that the nation will face. Chief among those problems is the future of Medicare, the national health-insurance plan. Medicare was enacted in 1965, under the administration of Lyndon B. Johnson, in order to provide health insurance for retired citizens and the disabled (Ryan). The Medicare program covers most people aged 65 or older, as well as handicapped people who enroll in the program, and consists of two health plans: a hospital insurance plan (part A) and a medical insurance plan (part B) (Marmor 22). Before Medicare, many Americans didn't have health

America is without a question the leading country of medical and scientific advances. There always seem to be a new medical breakthrough every time you watch the news or read the paper, especially in the cure of certain diseases. However, the medical research requires an enormous amount of money. The U.S. spends the most money on health care yet many people, mainly the working class Americans are still without any type of health insurance and thus are more susceptible to health risks and problems. The concept of health insurance for Americans was formulated over a century ago. Most Americans obtain health insurance from

Although Medicare-for-all seems like a viable option for our country’s ongoing battle with healthcare access and coverage issues, there are several tradeoffs that must be considered. From a healthcare provider’s perspective, universal coverage will significantly increase the volume of services demanded at any given point in time. If enacted, Medicare-for-all will permit millions of previously uninsured Americans to obtain coverage in a relatively short period of time. In turn, healthcare providers, who are already struggling to meet the increased demand of expanded coverage under the Affordable Care Act, will face an even greater influx of patients with the same number of resources. Each day, physicians will be required to see more patients than before, take on a larger care burden, and as a result, be faced with provider burnout due to increased mental and physical strain (Christopher, 2017). The Agency for Healthcare Research and Quality maintains that there is a consistent relationship between overexerted, fatigued physicians and lower levels of care quality and patient safety (“Physician Burnout,” 2017).