Introduction
The Medicare program is a health policy in the United States that provides health insurance coverage to people aged 65 and over. Medicare also provides coverage for people with specific disabilities. The Centers administer the program for Medicare and Medicaid Services (CMS). Payroll taxes, premiums, surtaxes from beneficiaries, and general revenue fund Medicare. In 2016, Medicare spending accounted for about 15% of U.S. health spending. There are four parts to the Medicare program: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (supplementary health coverage). Beneficiaries eligible for Medicare must also be enrolled in a Social Security number.
The Medicare program is popular among seniors, who account for about two-thirds of enrollees. About half of all beneficiaries are aged 65 or over, and about one-third are aged 75 or over. Medicare is a longstanding part of the U.S. healthcare system. The program began in 1965 as a pilot project to provide health insurance coverage to people aged 65 or over who did not have insurance. In 1974, it became an all-encompassing program. Medicare has been credited with helping to reduce the growth in spending on health care by offsetting some of the costs for retirees and people with disabilities. The Affordable Care Act (ACA) is responsible for significant changes to Medicare. This article will analyze and evaluate the Medicare program and identify the application of Medicare into clinical practice.
Analysis And Evaluation Of The Health Policy
History Of The Medicare Program
The Medicare program was established in 1965 under the administration of President Lyndon B. Johnson. The program was created in response to the increasing number of Americans over the age of 65 who were unable to afford private health insurance (Johnston et al., 2021). Medicare is a federally-funded health insurance program that provides coverage for seniors and disabled Americans. The Centers administer the program for Medicare and Medicaid Services (CMS).
Medicare was divided into Part A, Part B. Part A covers hospitalization costs, and Part B covers doctor and other outpatient services (Johnston et al., 2021). Individuals who are age 65 or older and have been continuously enrolled in Medicare since its inception are automatically enrolled in Part A. Those who are not automatically enrolled can enroll in Part A by visiting a participating hospital or clinic. The monthly premium for Part A is based on income and is payable by the individual, their employer, or the government. In 2006, nearly 54 million people had coverage under Part A of Medicare.
The Medicare program has been controversial since its inception. Some people have argued that the program is too expensive, while others believe it is necessary to provide health coverage for seniors (Johnston et al., 2021). The Medicare program is also controversial because it does not cover all of the costs associated with healthcare. For example, Part A of Medicare does not cover prescription drugs or dental care.
The Medicare program has been subject to several rounds of reform. In 2003, President George W. Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The MMA created a Medicare prescription drug benefit allowing seniors to purchase drugs from private pharmacies rather than government-run pharmacies (Johnston et al., 2021). In 2010, President Barack Obama signed the Affordable Care Act (ACA), also known as Obamacare. The ACA requires all Americans to have health insurance or face a penalty. Part of the ACA’s goal was to expand Medicare coverage to those who were not eligible (Johnston et al., 2021). Under the ACA, individuals aged 65 or older who have received Medicare benefits for at least three years are automatically eligible for coverage under Part A of Medicare.
An Overview Of The Medicare Program
The Medicare program is a health insurance program for people 65 years or older or with specific disabilities. The Centers administer the program for Medicare and Medicaid Services (CMS), which is a part of the U.S. Department of Health and Human Services (HHS) (McWilliams et al., 2018).
Medicare comprises four parts: Part A, Part B, Part C, and Part D. Part A covers hospital expenses, including inpatient care and outpatient services. Part B covers doctor visits, outpatient care, and preventive health services like cancer screenings and birth control. Part C covers the cost of prescription drugs and other medical treatments (McWilliams et al., 2018). Part D provides financial support for people who need help paying their Medicare bills. This part of the program is known as Medicare supplemental insurance (SMI).
People eligible for Medicare can choose whether to enroll in Part A or B. People aged 65 or older or with a disability are automatically enrolled in Part A. People who are younger than 65 years old or who do not have a disability can enroll in Part B. People can also enroll in Parts A and B together (McWilliams et al., 2018). This is known as dual enrollment. Dual enrollment allows people to cover the costs of Parts A and B with one payment.
The Four Parts Of The Medicare Program
Part A (hospital insurance)
Part A is hospital insurance that helps pay for inpatient care in a hospital or skilled nursing facility following a hospital stay, some home health care, and hospice care. Contributions are based on income and may be paid by the employee, the employer, or both (Meyers & Johnston, 2021). There is no deductible or co-pay for hospital care in Part A. However, coinsurance and other out-of-pocket expenses apply (Meyers & Johnston, 2021). Inpatient care covered under Part A includes services related to childbirth, deliveries, and related medical conditions.
Part B (medical insurance)
Part B helps pay for medically-necessary and preventative services, which can help prevent illness or disease. Part B also covers some clinical research and limited outpatient prescription drugs (Meyers & Johnston, 2021). Part B is divided into three parts: hospital, medical services, and prescription drugs. Inpatient hospital services include inpatient stays in a short-term or long-term care facility. Medical services include doctor visits, lab work, X-rays, and surgery (Meyers & Johnston, 2021). Prescription drugs are medications that are required by a patient but that are not available over the counter.
Part C (Medicare Advantage)
Medicare Part C, also called Medicare Advantage, is a way for Medicare beneficiaries to receive their Medicare benefits through a private health insurance plan. Medicare Advantage plans must provide the same coverage as Original Medicare, including coverage for hospital, doctor, and outpatient care (Meyers & Johnston, 2021). The plans must also offer various other benefits, such as prescription drugs, dental care, and mental health services.
Part D (supplementary health coverage)
Part D of the Medicare program is supplementary health coverage that helps cover the costs of prescription drugs. It is available to Medicare beneficiaries with prescription drug coverage through a Medicare Advantage Plan (Part C) or a private plan (Meyers & Johnston, 2021). Part D premiums are based on income and are capped at $2,970 per year for individuals and $5,290 per year for families. Medicare program is eligible for people who are 65 years or older, people who are under 65 years and have a disability, and people with End Stage Renal Disease (ESRD)
How the Affordable Care Act (ACA) Expanded The Medicare Program
The Affordable Care Act (ACA) expanded the Medicare program in some ways. First, it lowered the eligibility age for Medicare from 65 to 63 (Rivera-Hernandez et al., 2021). This means more people can now enroll and receive program benefits. Second, the ACA expanded the list of covered services under Medicare (Rivera-Hernandez et al., 2021). This includes adding coverage for preventive care, such as screenings for cancer and diabetes, and mental health services. Finally, the ACA increased the reimbursement rates for doctors who treat Medicare patients (Rivera-Hernandez et al., 2021). This means that Medicare patients will receive higher-quality care at lower costs. All these expansions make the Medicare program more accessible and affordable for people across the United States.
Application Of Medicare Program Into Clinical Practice
The Medicare Program can be applied to clinical practice in various ways, depending on the individual patient’s needs. However, some examples of how the Medicare Program can be used to improve patient care include providing coverage for preventive care services, ensuring access to necessary treatments and medications, and covering the cost of hospitalization (Rivera-Hernandez et al., 2020). Additionally, the Medicare Program can help improve care coordination by providing patients with a single point of contact for all their healthcare needs. Finally, the Medicare Program can help to ensure that patients have access to quality and affordable health care by monitoring hospitals and doctors for compliance with standards set by the program (Rivera-Hernandez et al., 2020). Overall, the Medicare Program is an essential source of financial support for patients and providers in the United States. Its use in clinical practice can benefit patients and providers significantly.
Conclusion
The Medicare program is a vital health policy in the United States that provides healthcare coverage for millions of Americans. In addition, the program helps to ensure that all Americans have access to quality healthcare. A program is an essential tool for clinical practice, as it provides reimbursement for many essential services to patient care.
The Medicare program is a vital health policy in the United States that provides healthcare coverage for millions of Americans. The program is crucial for seniors who often cannot afford private health insurance. In addition, the Medicare program helps to ensure that all Americans have access to quality healthcare. A program is also an essential tool for clinical practice, as it provides reimbursement for many essential services to patient care. In conclusion, the Medicare program is a critical health policy in the United States that provides essential healthcare coverage and helps to ensure quality care for all Americans.
References
Johnston, K. J., Hammond, G., Meyers, D. J., & Joynt Maddox, K. E. (2021). Association of Race and Ethnicity and Medicare Program Type With Ambulatory Care Access and Quality Measures. JAMA, 326(7), 628–636. https://doi.org/10.1001/jama.2021.10413
McWilliams, J. M., Hatfield, L. A., Landon, B. E., Hamed, P., & Chernew, M. E. (2018). Medicare Spending after 3 Years of the Medicare Shared Savings Program. New England Journal of Medicine, 379(12), 1139–1149. https://doi.org/10.1056/nejmsa1803388
Meyers, D. J., & Johnston, K. J. (2021). The Growing Importance of Medicare Advantage in Health Policy and Health Services Research. JAMA Health Forum, 2(3), e210235. https://doi.org/10.1001/jamahealthforum.2021.0235
Rivera-Hernandez, M., Blackwood, K. L., Mercedes, M., & Moody, K. A. (2021). Seniors do not use Medicare.Gov: how do eligible beneficiaries obtain information about Medicare Advantage Plans in the United States? BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06135-7
Rivera-Hernandez, M., Blackwood, K. L., Moody, K. A., & Trivedi, A. N. (2020). Plan Switching and Stickiness in Medicare Advantage: A Qualitative Interview With Medicare Advantage Beneficiaries. Medical Care Research and Review, 107755872094428. https://doi.org/10.1177/1077558720944284
write