Overview of Medicare
Medicare is a health insurance program run by the federal government for adults 65 and older, as well as certain younger people who have severe and persistent impairments. The Centers for Medicare & Medicaid Services is the federal agency in charge of Medicare (Jones et al., 2019). Because it is a federal program, the government controls Medicare’s budget and the services it provides. This implies that all 50 states share the same Medicare benefits. Two U.S. (Marmor, 2017). Medicare expenses are paid out of Treasury trust accounts. Diverse sources of funding contribute to the trust funds (such as payroll taxes and money appropriated by Congress).
Medicare Coverage and Extent
Products and services that are acceptable and required for the evaluation or treatment of a disease or disability are the only ones covered by Medicare. Among the types of Medicare are Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and Medicare Part D (prescription drug coverage). The Original Medicare System, or Part A of Medicare, covers medical care received in a hospital setting. Coverage includes limited home healthcare and hospice care, as well as short-term stays in hospitals and skilled nursing facilities (Marmor, 2017). Part B of the Medicare insurance plan pays for routine medical treatment such as regular doctor’s visits, physical therapy, medical supplies, and emergency room visits.
This is Medicare Coverage Option C. These policies offer coverage for both Parts A and B under one umbrella. Private insurance businesses offer Medicare Advantage plans, which are regulated by Medicare (Andes et al., 2019). There are options for public consultation in the evidence-based process that determines national coverage determinations. For every coverage term, Original Medicare covers a maximum of 90 days of hospitalization treatment. Therefore, the coverage and extent of Medicare depend on the type of Medicare and hospitalization history.
Medicare in the American Healthcare System
Medicare is a government assistance program that mostly serves the elderly, those with disabilities, and those with modest incomes. The only option for everyone else is to sign up for a private plan, either through their work or independently (Jones et al., 2019). There is a list of accessible products and services that are available to any patient who uses Medicare plans. Hospital treatment, doctor visits, prescriptions, preventive services, skilled nursing unit care, residential care, and hospice care are all examples of medical care.
With the availability of specific plans, patients are capable of undergoing hospitalizations without financial burdens. Patients can qualify for Medicaid assistance to offset Medicare expenditures like coinsurance and deductibles, as well as for non-Medicare health services like dental services and transport to doctor’s visits. Therefore, as one can see, Medicare offers services that meet the needs of every patient and allow different payment systems to finance the treatment of individuals.
Accomplishment of Medicare
Over the past decades, Medicare has been successful in doubling the proportion of Americans 65 and older with medical insurance, expanding access to standard medical services, and significantly lowering the financial pressures that older Americans must bear (Marmor, 2017). Moreover, Medicare was essential in hastening the segregation of medical centers (Marmor, 2017). For instance, a hospital stay, a stay in an SNF, some home health care visits, and hospice care are all covered under Part A. There is a deductible to pay before receiving Part A benefits in 2019 ($1,364 for each benefit term).
Visits to the doctor, preventative care, outpatient services, and certain home health care services are all covered under Part B. There is a deductible for many Medicare Part B services ($185 in 2019) and a usual coinsurance of 20% (Marmor, 2017). Part C, often known as Medicare Advantage, is a program that allows Medicare recipients to obtain all of their Part A and Part B benefits, and often their Part D. A lot of legislators still place Medicare transformation highly on their priority list due to the program’s recent and anticipated rapid growth. Thus, Medicare makes healthcare services for Americans more accessible.
Challenges for Medicare
Still, it is vital to mention that Medicare faces numerous challenges. The combined GDP contribution of Medicare in 2025 is projected to be 3.95 percent (Marmor, 2017). About 20% of the population will be enrolled in Medicare (shown in the figure). Meanwhile, the impact on patients is immense, and enrolment is not centralized under any specific government agency. However, beneficiaries are instead bombarded with messages from various unrelated sources.
Secondly, there may be financial consequences for beneficiaries if they either miss the deadline or select the incorrect health plan (Marmor, 2017). Third, beneficiaries have only seven months before their 65th birthday to choose a plan, which can cause them to feel pressured into making a hasty decision. To round things up, comparing health insurance policies is still difficult. While CMS worked to make the Medicare Plan Finder website easier to use, some users have complained that the new version still has the same issues.
Health Promotion
A wide range of strategies is employed in preventive medicine. Environmental variables, genetic reasons, disease vectors, and lifestyle choices all have a role in the development of diseases and impairments, and this development is a dynamic process that takes place before an individual is even aware of its effects (Marmor, 2017). Even if they are in good health, adults and children should make regular visits to the doctor for a variety of reasons, including screening for diseases, identifying risk factors for disease, discussing health and balancing one’s lifestyle, learning about the most up-to-date immunization and promotion measures, and maintaining positive relationships with medical staff.
Summary
Among the many pressing problems and obstacles that Medicare must overcome, serving an increasingly elderly population at a reasonable cost while safeguarding the program’s long-term financial health is of paramount importance. Medicare includes several types, such as A, B, and D, which are responsible for different kinds of coverage and services. Medicare helps renegotiate healthcare coverage and copayments and raises the healthcare eligibility age (Marmor, 2017). Medicare reform proposals should be evaluated for their potential impact on beneficiaries’ access to excellent care and affordable coverage.
References
Andes, L. J., Li, Y., Srinivasan, M., Benoit, S. R., Gregg, E., & Rolka, D. B. (2019). Diabetes prevalence and incidence among Medicare beneficiaries—United States, 2001–2015. Morbidity and Mortality Weekly Report, 68(43), 961.
Jones, C. M., Compton, W., Vythilingam, M., & Giroir, B. (2019). Naloxone co-prescribing to patients receiving prescription opioids in the Medicare Part D Program, United States, 2016-2017. Jama, 322(5), 462-464.
Marmor, T. R. (2017). The politics of Medicare. Routledge.
