Medicare – Publicly Financed Health Care Program

Medicare Program Overview

• The selected publicly financed health care program  is Medicare
• Medicare refers to federal health insurance program covering elderly people
• It covers individuals aged 65 and above
• It also covers particular younger persons with disabilities
• It also covers individuals with End-stage renal disease
• Medicare program is based  on Medicare law that was signed by president Lyndon in 1965
• It is currently connected to the social security (Rabkin, 1996).

Medicare is a federal health insurance program that is highly based on social security. The program is based on Medicare law that was signed in 1965 to cater for the elderly aged from 65 and above. Although it was initially meant only for elderly, the law has been modified in a number of occasions to handle more people who are in great need of health care services. Its main aim was to provide medical insurance to individuals that would hardly get it from private institutions due to high probability of utilizing their insurance funds; high possibility of experiencing severe health issues due to age, disabilities, or earlier diagnosis (Rabkin, 1996).

• Medicare contains different parts that assist in covering certain services
• These parts run from A to D
• Medical Part A: hospital insurance
• This covers care in skilled nursing facility, hospice care, inpatient hospital stays, and certain home health care
• Medicare Part B: Medical Insurance
• This covers particular preventive services, doctor’s services, medical supplies and outpatient care
• The payment of part A and B are by payroll taxes  and social security income deduction  (Medicare.gov, n.d.).

Constance Medicare law advancements or modifications resulted to the establishment of different levels of the Medicare insurance. It eventually resulted to four parts of Medicare insurance named as Part A, B, C, & D. Each part contains its unique provisions. Medical Part A is referred to as hospital insurance. It provide insurance cover to ensue in skilled nursing facility care, hospice care, inpatient hospital stays, and certain home health care. Medicare Part B was the second to be defined. It is also referred to as Medical Insurance. This provides insurance cover to particular preventive services, doctor’s services, medical supplies and outpatient care. Both Parts A and B payment are made by payroll taxes and social security income deduction (Medicare.gov, n.d.).

• Medicare Part C: Medicare Advantage plan
• Offered by private company which communicates with Medicare to offer the beneficiaries with all their Part B and Part A benefits
• The plan comprises of Medicare medical savings account plans, health maintenance organizations, special needs plans, private fee-for-service plans, and preferred provider organizations
• Most Medicare under this plan provide drug prescription coverage (Medicare.gov, n.d.).

The third part to be unveiled was Medicare Part C also referred to as Medicare Advantage plan. This part is provided by private company which communicates with Medicare to offer the beneficiaries with all their Part B and Part A benefits. The plan comprises of Medicare medical savings account plans, health maintenance organizations, special needs plans, private fee-for-service plans, and preferred provider organizations. Most Medicare under this plan provide drug prescription coverage. This part provides extensive coverage and a chance for beneficiaries to make a choice of the plan that is best for them. This is mostly due to the fact that this plan allows for private insurance under the Medicare (Medicare.gov, n.d.).

• Medicare Part D: Prescription drug coverage
• In this group prescription drug coverage is added to the initial Medicare
• The part also adds Medicare medical savings account plans, Medicare private-fee-for-service plans, and Medicare cost plans
• Payments for Part D and C are  paid by program participants out their own pockets (Medicare.gov, n.d.).

Medicare Part D is the last and the most recent Medicare part to be unveiled. It can also be referred to Prescription Drug Coverage.  This part allows for the addition of the prescription drug coverage to the initial Medicare provision; Part A and B. The part in addition adds Medicare medical savings account plans, Medicare private-fee-for-service plans, and Medicare cost plans. It therefore plays a great role in enhancing good treatment plan for the beneficiaries especially by ensuring that the beneficiaries can use the insurance cover to perchance the needed medication. The Parts D and C of Medicare are paid by beneficiaries from their own pockets (Medicare.gov, n.d.).

Medicare Evolution and Influence the Entire U.S. Health Care System

• Medicare law was initially enacted in 1965
• Its implementations started in 1966 with American seniors’ enrollment in Part A and Part B
• The first change was made in 1972 by President Nixon
• Nixon expanded if coverage to incorporate people under 65 years but with end-stage renal disease and long-term disabilities
• In 1980 the Act of Omnibus Reconciliation was passed which extended Medicare benefits to home health services (Rabkin, 1996).

As stated earlier Medicare program has been evolving with time. It was initiated in 1965 by signing of the Medicare Law. This was followed by its initial implementation in 1966 where elderly people aged from65 and above started benefiting from this program. The beneficiaries mostly enrolled through Medicare Parts A and B. In 1972, the Medicare program was advanced by President Nixon to accommodate younger people; below 65 who were struggling with End-Stage Renal diseases which is an expensive condition to manage as well as individuals who were suffering from long-term disabilities. This made it clear that Medicare program was basically targeting those who are in great need of medical care but with limited resources o abilities to handle their medical bills. More advancement were experienced in 1980 when Omnibus Reconciliation Act was signed to expand Medicare benefits to elderly or disabled receiving their health care services at their homes (Rabkin, 1996).

• In 1990s new laws were made to accommodate low-income individuals
• This included individuals with income from 100 and 120% level of federal poverty
• Medicare part C was also implemented during 1990s where new prescription drug were included in the coverage
• In 2000s individuals younger than 65 suffering from amyotrophic lateral sclerosis were enrolled into Medicare
• The 2003 Act of Medicare prescription Drug Improvement and Modernization (Anderson, 2016).

The expansion of Medicare continued to 1990s where new legislation was created to accommodate people with low income. This included individuals with income from 100 and 120% level of federal poverty; meaning covering  American citizen with living below the country’s poverty level and those who were slightly above it. This group was included based on the assumption that their income could not manage to cater for medical needs. Moreover high level of poverty is associated with poor health and hence, this group was highly vulnerable and it needed medical protection. Medicare part C was also implemented during 1990s, where new prescription drug were included in the coverage. Another modification was made in 2000s where individuals younger than 65 suffering from amyotrophic lateral sclerosis were enrolled into Medicare. Similarly in 2003 Medicare prescription Drug Improvement and Modernization Act was passed to modify the Medicare program even further (Anderson, 2016).

• The 2010 act of Patient Protection and Affordable Act was enacted
• It comprised of a long reform provisions list intended to reduce Medicare costs while rising revenue
• It also considered streamlining and improving its delivery system and increasing the program services
• This has resulted to increase in the number of American enrolled in Medicare insurance (Anderson, 2016).

New advancement was also recorded in 2010 with enactment of act of Patient Protection and Affordable Act as enacted. This act comprised of a long reform provisions list intended to reduce Medicare costs while rising revenue. It also considered streamlining and improving its delivery system and increasing the program services. This resulted to increase in the number of American enrolled in Medicare insurance as the insurance focused on covering more and more people with inability to handle high medical bills but high chances of being in need of medical services. This act focused on reducing the amount that need to be paid by the patient, while increasing the amount to be paid by the insurance (Anderson, 2016).

• in 2015 Medicare and CHIP Reauthorization Act was passed
• This served as a facilitator for CMS to fight for changes to how doctors are paid by Medicare for care
• There was change of payment from 2016 to value and quality based on the number of services given to Medicare beneficiaries by doctors
• MACRA in addition extended the program of Qualified individual for particular low-income members in premium payments in part B (Cms.gov, 2015).

The changes in Medicare program have continued up to the recent past. In 2015 Medicare and CHIP Reauthorization Act was passed. This Act served as a facilitator for CMS to fight for changes to how doctors are paid by Medicare for care. There was change of doctors’ payment in 2016 to value and quality based on number of services given to Medicare beneficiaries by doctors. This was meant to increase on care efficiency and quality since performance in the ratio to the number of patient served was considered in the new payment system. MACRA in addition extended the program of Qualified Individuals for particular low-income members in premium payments in part B (Cms.gov, 2015)

• Medicare has influenced U.S. healthcare system by making focus more on insuring those that desperately need healthcare services
• It focuses on the elderly, disabled and younger individual with chronic illnesses that include renal disease
• Medicare has assisted in enhancing quality of care given to aging population that is characterized by high rate of chronic illnesses
• It has also assisted in enhancing end of life care quality to the elderly
• Beneficiaries are individuals who need health care services the most
• It has therefore played a great role in ensuring maximum health care benefits to the population (Cms.gov, 2015)

Medicare has influenced U.S. healthcare system in various ways. One way is by focusing more on insuring those that desperately need healthcare services. The program is meant to cater for elderly, disabled and younger individual with chronic illnesses that include renal disease. Medicare has in addition assisted in enhancing quality of care offered to the aging population, which is characterized by high rate of chronic illnesses. It has also assisted in enhancing end of life care the elderly and those suffering from chronic diseases.  Medicare beneficiaries include individuals who need health care services the most (Cms.gov, 2015).

• While other insurance tries to cover those without medical history, this insurance focused on the population with medical issues or with high likely of having those issues in the near future
• Medicare therefore reduces medical cost and increase access of healthcare services to beneficiaries
• Availability of proper care to those that needs it most has increase the survival rate and prolonged life for the program beneficiaries (Davis, Schoen & Bandeali, 2015).

Medicare is a special insurance that gives cover to those that will surely make use of it exhaustively. While other insurance tries to cover those without medical history, this insurance focused on the population with medical issues or with high likely of having those issues in the near future. Medicare therefore reduces medical cost and increase access of healthcare services to beneficiaries. Availability of proper care to those that needs it most has increase the survival rate and prolonged life for the program beneficiaries. Medicare has therefore played a great role in ensuring maximum health care benefits to the beneficiaries and the society at large by eliminating distress experienced by those the patient depends on for medical bills payments (Davis, Schoen & Bandeali, 2015).

Medicare Accomplishments and Challenges

• Medicare has accomplished two main goals
• It has ensured quality healthcare access to disabled and elderly beneficiaries
• It has protected disabled and elderly over the health care costs financial hardship
• Medicare has increased insurance coverage beneficiaries at a higher percentage
• Today it covers around 55 million of disabled and elderly
• It eliminate disparities between poor and rich in health care provision
• It supports advance in health care delivery (Davis, Schoen & Bandeali, 2015)

Medicare has accomplished two main goals. It has ensured quality healthcare access to disabled and elderly beneficiaries. In normal circumstances, elderly and disabled could only manage huge medical bills by being assisted or by depending on others. This makes it hard for those without reliable people to depend on to suffer or die prematurely due to lack of proper medical care. Thus, has protected disabled and elderly over the health care costs financial hardship. Since its establishment, Medicare program has increased insurance coverage beneficiaries at a higher percentage. Today Medicare covers around 55 million of disabled and elderly. It also eliminate disparities between poor and rich in health care provision and supports advance in health care delivery to the beneficiaries (Davis, Schoen & Bandeali, 2015).

• It has reduced the number of elderly without  medical insurance from 48% to 2%
• It has reduced the amount paid directly from the pocket by American to 13% from 56%  experienced in 1966
• Thus Medicare has molded the U.S. health care system to better
• It has also responded to health care needs among the people that need it more (Cms.gov, 2015).

Medicare has played a great role in promoting good health and eliminating disparities in healthcare provision in the country. It has reduced the number of elderly without medical insurance from 48% to 2%. Meaning more people who could not access medical insurance due to lack of eligibility; mostly due to age or existing medical condition can now benefit from medical insurance.  Medicare has reduced the amount paid directly from the pocket by American to 13% from 56% experienced in 1966. Medicare can therefore be said to have molded the U.S. health care system to better. It has also responded to health care needs among the people that need it more (Cms.gov, 2015).

• In 2013, about 37.2 million beneficiaries of Medicare received a minimum of one free preventive services
• About 4.3 million individuals  with disabilities and elderly saved $3.9 billion, which is an average of $911 per beneficiary on prescription drugs
• The change of doctors payment system improved on the efficiency and quality of care
• The system also reduced waiting time and hence increasing chances of saving life (Cms.gov, 2015).

Medicare has achieved a lot in enhancing medical access and reducing medical cost in the country. In 2013, about 37.2 million beneficiaries of Medicare received a minimum of one free preventive service. This means that Medicare played a great role in reducing medical cost by promoting diseases prevention rather than treatment. In 2014, about 4.3 million individuals with disabilities and elderly saved $3.9 billion, which is an average of $911 per beneficiary on prescription drugs.  The change of doctors’ payment system improved on the efficiency and quality of care. The system also reduced waiting time and hence increasing chances of saving life. This demonstrates benefits initiated by Medicare program  (Cms.gov2015).

• Medicare has reduced the health care cost burden among the disabled and elderly among other beneficiaries
• Medicare has also increased the quality of care that the beneficiaries can get despite of their financial status
• Medicare insurance benefits are advanced t o prescription drug which plays a great role in reducing medical care cost among elderly with chronic illness (Davis, Schoen & Bandeali, 2015).

Medicare focuses purely on individuals without physical ability to generate enough money to take care of their health care cost. Thus reducing medical cost through Medicare has reduced the health care cost burden among the disabled and elderly among other beneficiaries. Medicare has also increased the quality of care that the beneficiaries can get despite of their financial status. In so doing, Medicare has eliminated disparities, and increased survival rate among elderly, disabled, and individual with chronic illnesses.  Medicare insurance benefits are advanced to prescription drug which plays a great role in reducing medication cost among elderly with chronic illness and other beneficiaries. This promotes their care, condition management and survival rate a great deal (Davis, Schoen & Bandeali, 2015).

• Medicare has been reported to perform much better compared to private insurance
• The chances of not getting required assistance are less probable with Medicare than private insurance
• It is unlikely for Medicare beneficiaries to get unmanageable medical bills
• The insurance efficiency is commendable even more than employment based medical insurance (Davis, Schoen & Bandeali, 2015).

Before the development of Medicare program, most patients in this category relied on private medical insurance and government insurance which did not cover the Medicare targeted groups. Private insurance were also found to be considerably bias mostly when compensating or covering their beneficiaries.  Even today, Medicare has been reported to perform much better compared to private insurance. The chances of not getting required assistance are less probable with Medicare than private insurance. It is unlikely for Medicare beneficiaries to get unmanageable medical bills since the insurance always cares for about 75% to all eligible beneficiaries.  Medicare insurance efficiency is commendable even more than employment based medical insurance (Davis, Schoen & Bandeali, 2015).

• Challenges to Medicare program include:
  • Rising costs  influencing both the beneficiaries and federal budget
  • Increasing number of elderly with retirement of baby boomers is also a challenge
  • This has reduced the number of taxpayers while increasing the number of Medicare beneficiaries
  • The tax payers also pays much higher taxes to maintain Medicare insurance services, something that is not very welcomed by many (Davis, Schoen & Bandeali, 2015).

Medicare has been of great benefits to the targeted population. However, this has not been without a number of challenges. Some of the challenges to Medicare program include rising costs influencing both the beneficiaries and federal budget. Increasing medical cost is increasing the amount the federal need to set aside to fund Medicare program and also the amount individuals have to add to cover the cost completely. This is straining the economy and also increasing the chances that some beneficiaries will not manage to cover their part of the cost. Moreover, increasing number of elderly with retirement of baby boomers is also a challenge. This has reduced the number of taxpayers while increasing the number of Medicare beneficiaries. The tax payers also pay much higher taxes to maintain Medicare insurance services, something that is not very welcomed by many since it reduces individual net income (Davis, Schoen & Bandeali, 2015).

• The need for supplement coverage with other insurances increases administrative cost and complexity in health care cost payment
• Other challenges include
  • The need for extra  comprehensive traditional Medicare benefits
  • Need for enhanced financial protection for modest- and low-income beneficiaries
  • Need for reduced coverage complexity  (Davis, Schoen & Bandeali, 2015).

There are other challenges brought about by Medicare. Basically, Medicare does not cover the entire medical cost, but a higher percentage of it; 75%. This creates the need for supplement coverage with other insurances. This increases administrative cost and complexity in health care cost payment. This mostly happens as the health care administration tries to calculate the amount to be covered by every insurance and following up to ensure that the amount is paid as per the requirements.  Other challenges include the need for extra comprehensive traditional Medicare benefits, the need for enhanced financial protection for modest- and low-income beneficiaries and the need for reduced coverage complexity.  All this increases the amount demand and hence financial pressure on the government side (Davis, Schoen & Bandeali, 2015).

• Medicare beneficiaries  spend around 15% of their earning on health care  on average
• This is 10% more than what is spent by individuals that are below 65years and with no chronic illnesses covered in Medicare program
• High medical cost means increase in the amount the beneficiaries will need to top up from other covers or from their pockets (Davis, Schoen & Bandeali, 2015)

Medicare focuses on individuals that need constant health care services in life.  Moreover, most of these beneficiaries are either retired or not in a position to earn their income effectively like other citizens. In this regard, despite of great boost by the government, Medicare beneficiaries spend around 15% of their earning on health care on average. This is basically 10% more than what is spent by individuals that are below 65 years and with no chronic illnesses covered in Medicare program, who only use 5% of their income.  This high medical cost transpire to increase in the amount the Medicare beneficiaries will need to top up from other insurance covers or from their pockets (Davis, Schoen & Bandeali, 2015).

Medicare focus on health prevention and performance

• Medicare coverage reduces medical cost and hence encouraging earlier patient reporting to health care facilities
• This reduces development of severe conditions that would attract emergency calls
• It also reduces chances of admission and other cost related to it
• Insurance coverage of home and hospice services also assist in condition management reducing severity (Davis, Schoen & Bandeali, 2015).

Despite the fact that Medicare cover does not completely assist its beneficiaries in handling the medical cost, Medicare coverage reduces medical cost that the beneficiaries need to pay. This encourages earlier patient reporting to health care facilities. It also reduces development of severe conditions that would attract emergency calls or/and admission. In this regard, Medicare can be credited for reducing the medical cost and encouraging condition management. Insurance coverage of home and hospice services also assists in condition management reducing severity that would attract emergency call, and hospitalization. Basically, Medicare plays a great role in ensuring that those that are disadvantaged can afford to access to good health care services at the condition onset or when need be, avoiding severity and preventable premature death (Davis, Schoen & Bandeali, 2015).

• Medicare has improved rate of condition monitoring and hence easing early intervention
• Proper treatment of the reported condition is enhanced by availability of insurance funds to cater for high cost
• The new doctors payment methods has increased quality of care and efficiency
• This reduces negligence, medical error, hospitalization infection among other complications (Davis, Schoen & Bandeali, 2015).

Medicare offers chances of elderly, disabled and those in poor health condition to access medical services at home, in hospice, in nursing homes, and in hospitals. This means quality can be assured despite of where one is receiving his or her care. Thus Medicare has improved rate of condition monitoring and hence easing early intervention. Proper treatment of the reported condition is enhanced by availability of insurance funds to cater for high health care cost. This increases the health promotion process. The new doctors’ payment methods have increased quality of care and efficiency. This reduces negligence, medical error, and hospitalization infection among other complications. This has generally increased good health in the society, and reduced distress among other benefits (Davis, Schoen & Bandeali, 2015).

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