Abstract
Medicare is a federal healthcare insurance program that focuses on the healthcare needs of older people and individuals from lower backgrounds. This research has focused on features of the traditional Medicare and the Medicare Advantage program. The analysis has compared the two programs by analyzing the deductibles, copayments, and the lack of a cap on out-of-pocket spending. The research has also examined the structure of Medicare for All. From the findings, an effective program should be a single federal program. This is because the program ensures that all residents are covered and meets the needs of the entire population. Having a single-payer insurance plan is beneficial because it enhances universal coverage, equity, and easy access to healthcare coverage. The research has also covered the disadvantages of having a single-pair insurance plan, such as limited choices, increased taxation, and administration challenges. Therefore, this research is crucial to patients and healthcare providers because it provides key facts regarding the different Medicare plans and the advantages and disadvantages associated with each plan. Researchers and policymakers can, therefore, use the information to implement an effective insurance plan that will meet the healthcare needs of the entire population.
Introduction
Medicare is the federal healthcare insurance that focuses on the needs of people aged 65 or older. The insurance also covers the needs of the children and residents with poor healthcare conditions and disabilities. Healthcare spending in the U.S. depends on price and value. Specifically, the private prices are very high. There are efforts made by the provider and the insurer innovation to solve the issue, but this will be unknown for years. This paper will research the features of traditional Medicare, the features of the local Medicare Advantage Program, and the structures of Medicare.
Features of the Traditional Medicare
Traditional Medicare is the old-fashioned fee-for-science program. According to this model, the patient needs to visit the healthcare provider and submit the form to Medicare. The traditional deductibles refers to the amount of money that the insured person must pay before their ensure policy starts paying for the covered expenses (Agarwal et al., 2019). In traditional Medicare, the deductibles ensure the limit of the insured expense, after which the insurer will try accepting the claim. The process is essential because it helps the insurer to avoid minor and frequent claims. It also helps to cover the moral hazards involved in wrongfully using insurance plans.
The traditional form of Medicare covers inpatient hospital stays, care in a skilled nursing facility, hospital care, and part of health care (Miller, 2022). Part B of the Medicare plan covers the doctor’s services, diagnostic screenings, lab tests, and outpatient care. The plan also cares for outpatient care, preventive care, and medical equipment and transportation. On the other hand, traditional Medicare does not cover surgery or congenital external effects. Also, Medicare does not cover some benefits such as eye exams, dental care, and routine exams.
In terms of copayments, once one is enrolled in the traditional insurance plan, they are responsible for paying their premium. There is also a fee paid every time the medical services are provided. Lastly, the lack of a cap on out-of-pocket spending exposes part D enrollees to thousands of dollars in out-of-pocket costs.
Features of the Medicare Advantage Program
The Medicare Advantage plans offer emergency coverage outside of the plan service area. The majority of the plans also offer extra benefits such as dental care, eyeglasses, and wellness programs. Medicare bundles the Parts A, B, and D coverage into one. Each plan has different rules set by the Medicare (Zahner et al., 2022). The plan covers all the emergency and urgent care services and all the necessary services covered under the Original Medical coverage. Some of the items covered under this Medicare program, therefore, cover emergency coverage outside the plan’s service. It also provides extra benefits such as dental care, eyeglasses, and wellness programs. However, the program does not cover clinical trials and hospice services.
The deductibles of the program include the amount needed to pay for the covered healthcare series of the medical plan. Once individuals are satisfied with the deductible, they will pay only a copayment or coinsurance, and Medicare pays the rest. In this case, the Medicare Advantage requires the insured to meet a minimum deductible to access healthcare and prescriptions before the healthcare plan begins to pay for the healthcare services.
The copayments in the plan include a charge for the doctor’s visit instead of the 20% co-insurance under the regional Medicare. The medical advantage plans do not pay higher copays than the original Medicare in different fields such as dialysis, chemotherapy, and healthcare services that require skilled labor. Lastly, the caps on out-of-pocket spending include how much a health insurance policyholder will pay each year for the covered healthcare expenses. The maximum limit for part C is $8,850 for the approved services, while the individual services can set lower limits.
Structure of The Medicare for All
The Medical for All structure should be a single federal program. The program runs all the healthcare programs in which all Americans are covered and replaces all the existing public and private plans. This is believed to be the best plan because it covers all Americans and holds down their costs. The structure is also effective because it will cover all the essential treatments with no premiums or deductibles. It would also expand the benefits under the current medical systems and include areas such as dental and vision coverage (NBC News, 2019).
Advantages and Disadvantages of Single-payer Insurance Plan
A single-payer system is a streamlined financing mechanism where one entity administers all the healthcare payments and funding. The advantages of a single-payer insurance plan include the achievement of universal coverage, which ensures that all members of the public are insured. The plan also ensures affordability because there are no premiums and out-of-pocket costs. It also enhances access to care, especially for low-income earners. There is an elimination of employer and state government responsibilities, leading to reduced expenditure in providing healthcare services.
On the other hand, the plan has challenges, such as an increase in government revenue in terms of taxes. The policy increases the taxes by over 50% (Amigoni et al., 2023). Next, the plan is associated with cuts in healthcare revenue and incomes, which have large ramifications. The plan also needs help in administration. It is challenging to eliminate the current coverage and ensure that everyone is under the new system. Lastly, it eliminates the consumer choice of insurers.
Conclusion
In summary, Medicare focuses on delivering healthcare services to all individuals. The research has covered the components of traditional Medicare and the Medicare Advantage program. The two programs have distinct features that promote healthcare coverage. Medicare for All is a single federal program that enhances healthcare coverage. Also, from the research conducted, a single-payer insurance plan ensures equity, coverage, and access to healthcare. The plan also has challenges, such as higher taxation and poor governance issues.
References
Agarwal, R., Connolly, J., Gupta, S., & Navathe, A. S. (2021). Comparing Medicare Advantage And Traditional Medicare: A Systematic Review: A systematic review compares Medicare Advantage and traditional Medicare on key metrics, including preventive care visits, hospital admissions, and emergency room visits. Health Affairs, 40(6), 937-944.
Amigoni, F., Lega, F., & Maggioni, E. (2023). Insights into how universal, tax-funded, single-payer health systems manage their waiting lists: A review of the literature. Health Services Management Research, 09514848231186773.
NBC News. (2019, June 20). What is “Medicare for All” and how would it work? https://www.nbcnews.com/politics/elections/what-medicare-all-how-would-it-work-n1014256
Miller, M. (2022, April 22). Big changes may be coming to traditional Medicare. Morningstar, Inc. https://www.morningstar.com/personal-finance/big-changes-may-be-coming-traditional-medicare
Zahner, G. J., Croughan, P. W., & Blumenthal, D. M. (2022). Medicare Advantage for All: a potential path to universal coverage. JAMA, 327(1), 29-30.
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