Medicare, enacted on 1965 is one of the most important and inclusive government funded health insurance program which covers the elderly, the disabled and people with end stage renal diseases. With Medicare covering specifically the elderly and the disabled, the cost is usually on the higher side. There are different ways in which Medicare provides reimbursement and this usually is a machine run process with little scanning is done by human eyes, making it vulnerable to abuse and corruption. Also with the ever increasing number of people covered under Medicare and the number of claims that are filed daily it becomes really difficult to control Medicare malpractice. And if one learns the process of reimbursement, then there are many ways in …show more content…
It has been developed in a way that the present generation pays up for the healthcare of the generation that preceded them. Each year, the expansion and spending on Medicare and other government health insurance plans are growing way faster than that of the Gross National Income (GDP) of America but the quality of health amongst the one who are covered has not improved drastically. Medicare is a primary health insurance program for the senior citizens of USA above the age of 65 years. To be eligible for Medicare, either theses senior citizens or their spouses should have paid Medicare taxes for more than 40 quarters (Hanming Fang, 2008). About 97 percent of older Americans are covered by Medicare and the Medicare’s coverage area has also been expanded over the years. It now covers prescription drugs, in additional to that of hospital and outpatient care coverage. In the present times, Medicare covers about 47.5 million aged Americans and is expected to cover 18.4 percent of the population by 2020, which means more of the federal budget would be taken up Medicare (The Henry J Kaiser Family Foundation, 2015). “According to the latest statistics from the Center on Budget and Policy Priorities, Medicare alone makes up around 14 percent of the budget, or $452 billion” (Miller, 2013). Medicare consists of 4 parts out of which A and B were the originals, onto which C and D were
(II) The enacting of Medicare Part D in 2006 only helped to fuel America’s hunger for prescription medication. In 2003, President George W. Bush announced and signed the Medicare Prescription Drug, Improvement, and Modernization Act (also known as the Medicare Modernization Act, or MMA) on December 8th. The roughly $400 billion dollar measure was marketed to the American public as something that will provide care for the millions of senior citizens who, at the time, were struggling to afford prescription medication. This was the largest development of Medicare since 1965, which is when the program was initially created, and gave hope to those wishing for positive medical reform. According to title XI of the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003”, the most significant change will be the affordability of prescription drugs by implementing the importation of drugs from Canada, along with necessary safety measures, in order to lessen the cost (United States Congress, 832). For those who were in retirement homes and lacked a steady income, the affordability of drugs was often a deciding factor in the decision to seek medical attention and the idea that those individuals ceased to live simply because they lacked the funds tugged at the heartstrings of many Americans.
Medicare is a social policy many of our seniors look to for their stability when they reach 65
Medicare and Medicaid are one of important government programs. According to Medicaid.gov site, there are more than 4.6 million low-income seniors enrolled in Medicare and about 8.3 million people that are enrolled in both Medicare and Medicaid. Anyone that enrolled with Medicare and limited income and resources are eligible to get assistance paying for their premiums and out-of-pocket medical expenses from Medicaid. Not only does Medicaid cover additional services, but, services covered by both programs are first paid by Medicare with Medicaid in the difference up to the state’s payment limit (Medicaid.gov, 2015) .
Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities and people of any age with End-Stage Renal Disease. There are four subcategories of Medicare. Part A is for hospital stays or, with certain restrictions, at-home care for a limited number of days. Part B is more like regular medical insurance. It covers ambulatory care and physician fees. There is a deductible and are sometimes co-pays as well. Part C is presented as an alternative to parts A and B. It is where private insurance companies can contract with the federal government to offer Medicare benefits through their own policies. It can offer benefits not covered under original Medicare, although there might be a premium charged. Part D is the prescription plan for enrollees. (Centers for Medicare and Medicaid Services, 2010)
In recent years, the number of Americans who are uninsured has reached over 45 million citizens, with millions more who only have the very basic of insurance, effectively under insured. With the growing budget cuts to medicaid and the decreasing amount of employers cutting back on their health insurance options, more and more americans are put into positions with poor health care or no access to it at all. At the heart of the issue stems two roots, one concerning the morality of universal health care and the other concerning the economic effects. Many believe that health care reform at a national level is impossible or impractical, and so for too long now our citizens have stood by as our flawed health-care system has transformed into an unfixable mess. The good that universal healthcare would bring to our nation far outweighs the bad, however, so, sooner rather than later, it is important for us to strive towards a society where all people have access to healthcare.
The Patient Protection and Affordable Care Act passed by President Barack Obama is a significant change of the American healthcare system since insurance plans programs like Medicare and Medicaid (“Introduction to”). As a result, “It is also one of the most hotly contested, publicly maligned, and politically divisive pieces of legislation the country has ever seen” (“Introduction to”). The Affordable Care Act should be changed because it grants the government too much control over the citizen’s healthcare or the lack of individual freedom to choose affordable health insurance.
There are four components to the Medicare program, part A, B, C and D. Part A of Medicare covers in patient hospital services; patients have a financial responsibility to cover a deductible that is equivalent to 1 day of hospitalization, thereafter cost is covered at 100 percent for a maximum of 60 days. This also includes nursing facilities, home and hospice care. Part B covers outpatient surgery and physician office visits. This is an elective component of Medicare in that there is a premium associated with this plan that is paid for directly through social security payments. Part C is know as Medicare Advantage and is a supplemental policy that is purchased directly from employers; one may be denied for health reasons depending one when the plan is acquired. Part D is prescription drug coverage that is eligible to all individuals that qualify for Medicare. Beneficiaries of the Medicare choose which prescription plan they want and pay a corresponding monthly premium.
In 1965 President Johnson signed both Medicare and Medicaid programs into law (Nile, 2011). According to Medical news today, “Medicare is a social insurance program that serves more than 44 million enrollees as of 2008” (MediLexicon International Ltd, 2011, para2). It cost about $432 billion or 3.2% of GDP, as of 2007(par2).Medicare is broken down into parts, Part A is hospital Insurance Part B is medical Insurance, and Part D is Medicare prescription drug coverage (medicare.gov). Like we previously stated Medicare is a health insurance for people who are 65 and older, people under 65 with certain disabilities, and people of any age with End- Stage Renal Disease. Medicaid is a joint federal-state program of medical assistance for low income persons (Benefit.gov). It is administered by the Illinois Department of Human Services (DHS) and Illinois Department of Public Aid (IDPA). Medicaid serves about 40 million people as of 2007; it cost $330 billion, or 2.4% of GDP, in 2007.(par.2) “In Illinois you may be eligible for Medicaid if you are a child, pre...
Medicare provides healthcare coverage for individuals over the age of 65, in addition, to others meeting certain criteria. The government funds Medicare through the administration of the federal Centers for Medicare and Medicaid and spends billions annually, on the program. Fraud runs rampantly throughout the healthcare program due to the enormous amount of money spent and the large number of people enrolled in the program. Fighting fraud of this nature necessitates diligence by everyone. Protecting oneself entails understanding what constitutes fraud, identifying it, noting suspicious practices, and taking steps towards prevention.
According to Medicare’s WebPage Medicare is a Health Insurance Program for people 65 years of age and older, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant). Medicare has two parts, Part A which is for basically hospital insurance. Most people do not have to pay for Part A. In addition it has a Part B, which is basically medical insurance. Most people pay a small monthly fee for Part B. Medicare first went into effect in 1966 and was originally administered by the Social Security Administration. In 1977 the control of it was switched over to the newly formed Health Care Financing Administration. Beginning in July 1973 Medicare was extended to persons under the age of 65 with certain disabling conditions. In 1988 Congress passed legislation to expand the program to cover health care costs of catastrophic illnesses.
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
Medicare is a national social insurance program, run by the U.S. federal government since 1966 that promises health insurance for Americans aged 65 and older and younger people with disabilities. Being the nation’s single largest health insurance program, covering a large population for a wide range of health services, Medicare's funding is a fundamental part of it sustainability. Medicare is comprised of several different parts, serving different purposes, some of which require separate funding. In general, people at the age of 65 and older who have been legal residents of the United States for at least 5 years are eligible for Medicare. Same is true with people that have disabilities under 65, if they receive Social Security Disability Insurance benefits. Medicare involves four parts: Part A is hospital insurance. Part B is additional medical insurance, that Part A doesn't cover. Part C health plans, also mostly known as Medicare Advantage, are another way for original Medicare beneficiaries to receive their Part A, B and D benefits. Medicare Part D covers many prescription drugs, some of which are covered by Part B. Medicare is a major operation, not only needing adequate administering but the necessary allocated funds to keep this massive system afloat.
Less than a quarter of uninsured Americans believe the Affordable Care Act is a good idea. According to experts, more than 87 million Americans could lose their current health care plan under the Affordable Care Act. This seems to provide enough evidence that the Affordable Care Act is doing the exact opposite of what Democrats promised it would do. On the other hand, this law includes the largest health care tax cut in history for middle class families, helping to make insurance much more affordable for millions of families. The Affordable Care Act has been widely discussed and debated, but remains widely misunderstood.
There are numerous amounts of billing codes within the Medicare system. Many have the same codes to one medical piece of equipment. If a biller tries to make a claim for a device, such as a wheelchair and walker, and the claim was denied based on excessive usage of that particular code because of its geographic region, then the biller can easily resubmit the claim using an alternative code that will allow the claim to go through with minor alternations to the device (AGHAEGBNO, 2001). The biller can complete this task several times until the claim is satisfied. The biller can also bill for services that were not provided in order to receive higher payments from health care providers. These are forms of multiple, double and improper billing abuses that are defrauding the system tremendously. Health care claims are coming in quickly and some payments are even expedited and reused to medical provide...
One out of every five elderly Americans faces each day on a limited income with little flexibility for extra or unexpected medical expenses (Rowland & Lyons.). When medical care is needed, these 6 million poor and near-poor elderly Americans depend on Medicare for assistance with their medical bills. The universal coverage of Medicare assures them entry to America's health care system and offers protection from financial catastrophe when illness strikes. However, gaps in the opportunity of Medicare's benefits and financial obligations for coverage can result in onerous financial burdens. Low-income elderly people are particularly susceptible because they are more likely to be experiencing health problems that require medical services than those who are economically better off, but are less able to afford needed care because of their lower incomes.