Medicare Essay Example - Essay Prowess

Medicare Essay Example


Since early twentieth century, health care concerns have tremendously increased in the United States. Beginning from 1915, the government established health insurance programs aiming to relieve the random and unexpected occurrence of medical costs. The key concern at the period was whether to finance medical care through private or public funds (Kronenfeld, 2011). During the Second World War, the coverage of private health insurance significantly increased due to the increase in fringe benefit. The program was designed to recompense for the government regime confines on direct income increases. Consequently, the system continued following the end of Second World War. Most middle-income earners needed private health insurance especially those funded via the relationships in employment (Heiss, McFadden, & Winter, 2010). Nonetheless, not everybody could afford private health insurance. In this regard, the health policy makers sought involvement of the government.

The Congress proposed different national health insurance funded by payroll taxes. However, it is only in 1965 when Congress passed legislations that created the Medicare program. The program was included as Title XVII under the Social Security Act (Berwick, 2011). The amendment of the act in 1965, created two distinct but well-organized health cover designed for individuals 65 years or older. Part A of the program involved mandatory health insurance while Part B offered a voluntary program for Supplementary Medical Insurance (SMI). The legislature also passed various laws that extend Hospital Insurance to particular disable individuals below 65 years (Miller, 2012). In addition, legislation offers hospital insurance for people of whichever age suffering from end-stage kidney disease.

Subsequently, from 1977, the law authorized the Health Care Financing Administration (HCFA) with crucial duty for administering the Medicare program (Berwick, 2011). In addition, it established two trusts funds, for Supplementary Medical Insurance and Hospital insurance that are financed differently in the program. Moreover, by 2005, nearly 47 million people were registered for Part A while 46 million for Part B (Joynt, & Jha, 2013). Besides, the total amount of Benefit payments was approximately $ 184.2 billion of which Part B utilized $ 66.6 billion while Part A accounted for $117.6 billion. The total hospital insurance and supplementary medical insurance benefit payments for all the program accounted for $ 5 978 per enrollee in 2005 (Report to the Congress, 2011). In addition, for all people who enrolled for the Medicare program in 2005, only 22 percent used health Insurance whereas more than 84 percent utilized Part B services.

Medicare is a health insurance policy designed for the United States citizen who are 65 years or older, individual at any age suffering from End-Stage Renal Disease and people with particular disabilities. Medicare insurance covers for physian services and hospital stays whereas private insurances program provide alternative, supplemental or drug prescription coverage (A data book, 2012). Part A of Medicare provides Hospital insurance that covers for hospice care, inpatient care in patients and home health care. In addition, it also ensures that skilled nursing facilitate are covered to the maximum (Centers for Medicare & Medicaid Services, 2011). On the other hand, Part B of Medicare assists to cover outpatient care and services from physicians and other health care professionals. It also insures home health care services, some preventive services and durable medical equipment (Berwick, 2011).

Moreover, Part C provides Medicare returns that includes all services and benefits included in Part A and Part B. The private insurance firms that are approved by Medicare, manage this. Besides, Part D enables Medicare prescription drug coverage (Jensen, & Jacques, 2011). This helps to cover for prescription drugs cost and protects against high cost of drugs in the future.

Eligibility for Benefits

Hospital Insurance (Part A)

Individuals can benefit from Hospital Insurance cover when they reach 65 years and they are eligible for monthly benefits for Social Security. In addition, individuals protected via the Railroad Retirement System engage in the hospital insurance program on the similar grounds as those in Social Security scheme (Joynt, & Jha, 2013).

Moreover, persons who would acquire a monthly Social Security returns in case their service from the government were protected work pursuant to Social Security are also eligible for hospital insurance (Centers for Medicare & Medicaid Services, 2011). It permits individuals below 65 years of age and are disabled are eligible for Hospital Insurance provided by Social Security disability assistances for more than 2 years. Similarly, they are entitled to health insurance provided the employment in government is an insured work pursuant to the Social Security Act (Rowe, & Fried, 2013). Furthermore, patients suffering from End-stage Kidney Disease at whichever age and satisfy special insured position demands under Social Security are qualified for hospital insurance.

Meanwhile, individuals who are 65 year and beyond, who are ineligible for the returns can buy hospital insurance cover for a monthly premium of $ 200 in case they have Social Security protection of 30-39 quarters (A data book, 2012). However, for people with less than 30 quarters of social security protection, they are supposed to pay a monthly premium of $ 311 (Kronenfeld, 2011). In addition, Part B enrollment is needed as a demand for buying

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