Paste yoMedicare Policy
On November 19, 1945, seven months into his presidency, President Truman called on Congress for the creation of a national health insurance fund, that will be open to all Americans. The plan he envisioned would provide health coverage to individuals, and help with paying for such typical expenses as doctor visits, hospital visits, laboratory services, dental care and nursing services etc. Although he fought to get a bill passed during his term, he was unsuccessful and it would be another 20 years before it came into volition. Medicare for Americans 65 and older, rather than earlier proposals to cover qualifying Americans of all ages, would become a reality. President John F. Kennedy made his own unsuccessful push for a national health care program for seniors after a national study showed that 56 percent of Americans over the age of 65 were not covered by health insurance. But it wasn’t until after 1965 after legislation was signed by President Lyndon B Johnson that Americans started receiving Medicare health coverage .(Anderson, 2016, para. 2)
Medicare is a federal health insurance program for people age 65 and older plus under age 65 with certain disabilities, who have been receiving Social Security disability benefits for a certain amount of time (24 months in most cases) and people of any age who have End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a transplant. The time frame is for anyone who is a U.S. citizen or a legal resident who has lived for at least five years in the United States and is turning 65 is entitled to an initial enrollment period that lasts seven months from three months before the month of their 65th birthday, to three months after that month. Medicare helps with the cost of health care, but it does not cover all medical expenses. Medicare Has Four Parts.(p. 1)
Medicare Part A helps cover inpatient care in hospitals. Part A also helps cover skilled nursing facility care, hospice care, and home health care, under certain conditions. Medicare Part B helps cover medical services such as doctor’s services, outpatient care, and other medical services that Part A doesn’t cover. Part B also covers some preventive services, such as flu shots and diabetes screening, to help people maintain their health and to keep certain illnesses from getting worse. Medicare Advantage Plans, sometimes known as Medicare Part C, are health plans people can join to get their Medicare benefits. These plans cover hospital costs (Part A), medical costs (Part B), and, in most cases, prescription drug costs (Part D). Medicare Advantage Plans may also offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Medicare Advantage Plans are managed by private insurance companies approved by Medicare. Medicare Part D helps pay for medications that a doctor may prescribe. This coverage may help lower prescription drug costs. These plans are run by insurance companies and other private companies approved by Medicare.(p. 2)
Most people don’t have to pay a monthly fee, or premium, for Medicare Part A (hospital insurance) when they turn age 65 because they or a spouse paid Medicare taxes while they were working. Enrollment in Medicare Part B (medical insurance) is optional, and most people who choose Part B must pay a monthly premium. Some people with a higher income pay a higher Part B premium. Your state has programs that pay some or all of the Medicare premiums for people with limited income and resources.(p. 3)
The Centers for Medicare& Medicaid Services (CMS) is responsible for coordination of the policy. The Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office) serves people who are enrolled in both Medicare and Medicaid, Medicare-Medicaid enrollees, also known as dual eligible. Their goal is to make sure Medicare-Medicaid enrollees have full access to seamless, high quality health care and to make the system as cost-effective as possible. The Medicare-Medicaid Coordination Office works with the Medicaid and Medicare programs, across Federal agencies, States and stakeholders to align and coordinate benefits between the two programs effectively and efficiently. We partner with States to develop new care models and improve the way Medicare-Medicaid enrollees receive health care.(“CMS.gov,” para. 5)
The formula use to evaluate Medicare is very enticing to many. For hospitals, health systems and other providers, it has been the most influential healthcare program for the industry in recent decades. Hospitals that fall under CMS’ Inpatient Prospective Payment System agree to pre-determined rates in order to serve Medicare patients. About 3,400 acute-care hospitals and 435 long-term care hospitals receive payments under the IPPS. Hospitals generally receive IPPS payment on a per-discharge or per-case basis for Medicare beneficiary inpatient stays. Discharges are assigned to diagnosis-related groups, which sorts them by similar clinical conditions and procedures administered by the hospital during the stay. The IPPS per-discharge payment is based on two national base payment rates for operating expenses and capital expenses. These rates are adjusted to account for the patient’s clinical condition and related treatment relative to average Medicare case costs and for market conditions in the hospital’s geographic area. CMS updates the IPPS for each physical year.(Adamopoulos, August 19, 2014)
In the 50 years since they were signed into law by President Lyndon Johnson, Medicare and Medicaid have grown into health insurance behemoths, covering one-third of all Americans and accounting for $4 of every $10 spent on healthcare here. Widely supported by beneficiaries, the programs have been dramatically successful on many fronts: Medicare has extended health insurance to nearly all the elderly, Medicare were designed to plug gaping holes in health coverage for retirees and impoverished families back in the days when insurance was provided almost exclusively by employers. To finance Medicare, workers and employers paid payroll taxes into a fund for hospital coverage (Medicare Part A), and retirees paid income-based premiums if they wanted coverage for doctors’ visits (Part B). The programs are as large as they are today because they were expanded over the years to cover more people. Congress extended Medicare to the permanently disabled (who make up about a sixth of the enrollees) and people of all ages with advanced kidney disease, while also adding coverage for prescription drugs (Part D), with most of the cost falling on taxpayers. Although most of the beneficiaries of Medicare have been people of modest means, There’s also a clear benefit to public health in providing a third of the population access to care that might otherwise be unaffordable.(July 30th, 2015)
References
(). Medicare. Retrieved , from https://nihseniorhealth.gov/medicarebasics/whatismedicare/01.html
(). Medicare.gov. Retrieved , from https://www.medicare.gov/
(July 30th, 2015). Medicare and Medicaid at 50: Successful, expensive. Retrieved , from http://www.latimes.com/opinion/editorials/la-ed-medicare-medicaid-50-20150730-story.html
Adamopoulos, H. (August 19, 2014). 100 things to know about Medicare reimbursement. Retrieved , from http://www.beckershospitalreview.com/finance/100-things-to-know-about-medicare-reimbursement.html
Anderson, S. (2016, ). A brief history of Medicare in America. . Retrieved from https://www.medicareresources.org/basic-medicare-information/brief-history-of-medicare/
CMS-Medicare-Medicaid Coordination Office. (). Retrieved , from https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/index.html
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