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. One in six Americans and mostly all of the population 65 years and older, are covered by Medicare. In 2012, Medicare provided for 50.7 million people, 42.1 million aged and 8.5 million disabled, with a total cost of $574 billion. This is about 21% of national health spending and 3.6% of Gross Domestic Product (Davis, 2013). Medicare, being a social insurance program, is required to pay for covered services provided to enrollees so long as the specific criteria is met.
Fundamental Medicare coverage continued to focus on 60 days of hospitalization and 60 days of nursing home care, coverage for doctor’s bills was even an optional part of the plan. The elderly were the primary focus of coverage, and the social security approach was to be utilized as a framework for financing (Kronenfeld, 2011). In 1972, benefits were extended to younger individuals with permanent disabilities. Today, Medicare is a resource of health care for 45 million people, including 7 million who are younger than age 65 and disabled (Hooyman & Kiyak, 2011). Medicare Part A now includes any person aged sixty-five or older who has been employed for ten or more years subject to employment payroll taxes.
Two of the largest government funded insurance groups are Medicare and Medicaid. Between the two, they service upwards of 40% of the total American population(2010 & 2012, KFF). However, the two programs offer various similarities and differences. Medicare is a federal government-sponsored healthcare program primarily for seniors; Medicaid is for low-income families and is managed by both the state and federal governments. By performing a SWOT analysis on each program, it is possible to compare the two.
They are food redeemable vouchers that are given on average of $278 a month. Medicare is also provided to welfare dependents. It usually costs $4000 per person per year. The government also provides people with some sort of housing. It can be in a subsidized housing project, or the more recent option of providing rent for welfare recipients to live away from government subsidized building projects.
Many elderly individuals were faced with the problem of medical cost. In 1965 a bill was passed that provided coverage to all individuals 65 years of age and older, regardless of their income and health status called Medicare. Medicare is an insurance that covers doctors and hospital visits in which pays providers for the service that is given to the patient. In the first week of the plan being passed, 1 million enrollees purchased the plan. Since Medicare only reimbursed integrated hospitals for treating Medicare patients, this caused the end of racial segregation in hospitals.
Part B requires a 20% co-pay fee. This can be expensive if used very frequently. Typically, most Americans have these two Medicare plans which together are called original or traditional Medicare as it was the first two Medicare plans ever available to recipients. The third official Medicaid program which is part C. Part C is also known as Medicate advantage. This plans utilizes private insurance compiles use to deliver health insurance to you in addition to the benefits you might already reactive with Part A and Part B. Additionally to receive Medicaid advantage recipients must be currently enrolled in both Medicare part A and part B.
3.3 million Social Security and SSI claims and 326,000 SSI aged claims, (Social Security, 2011). These claims have to go to procedures that can take months to be approval. During these procedures, many more applicants are eligible to apply for social security and more money is pay to beneficiaries. In 2011, social security will collect $45 million less in payroll that it pays out in retirement, disability and survivor benefits, according to the nonpartisan Congressional Budget Office, (Ohlemacher, 2011). 54 million people receive retirement, disability or survivor benefits with an average payment of $1,076 a month, (Ohlemacher, 2011).
Social Security helped reduce this figure to 15.7 percent by 1980. 80 year-olds receive 50% percent of their yearly income from social security (Committee on the Aging Society, 1985). The rest of their income often comes from pension plans or family funds. Elderly populations consume significantly more medical resources than other age groups. In 1984 elderly were 12% of our population, but consumed 31% of medical resources; by 2040 they are expected to consume 45 %.
The SMI plan covers 80 percent of office visits, preventive medicine, surgery and diagnostic specialties (x-rays, etc.). What Medicare does not cover include: hospital stays over 60 days, extended nursing-home care, or the cost of lengthy illnesses. In the cases where Medicare will not cover costs, recipients usually use secondary retirement programs either from pension plans or retirement programs such as AARP (American Association for Retired People). Those who do not have such plans, are forced to drain their assets until they qualify for the sister program Medicaid. Medicaid is a program set up the same as Medicare but primarily for those who fall short of the state-specified income level.
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.