...Centers for Medicare and Medicaid Services Centers for Medicare and Medicaid Services Centers for Medicare and Medicaid, once called the Healthcare Financing Administration was signed into law on July 30, 1965 by President Johnson. The Medicare and Medicaid programs were created under the social security act to provide health insurance to people with disabilities, low income families, people 65 or older, or people with terminally ill disease. Medicare was once the responsibility of Social security administration, and Medicaid was once the responsibility of the Social and Rehabilitative Service Administration until in 1977 the Healthcare financing Administration was created administer both services. What led the production of these two health insurances was the belief in the 1940s that everyone is entitled to health insurance no matter what, but since then health care cost has risen drastically. Many health care providers are reluctant to offer services or the appropriate services to people with this type of insurance because only a set amount is covered and not all expenses are paid for. In America Medicaid and Medicare provide health insurance to millions of people every day, and it would be devastating if they failed and were no more, throughout this essay I will show shocking statics and facts on both of these health services and how they work. It is important for Americans to be knowledgeable on what our country’s health runs on and how financially Medicare and Medicaid...
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...Policy Process: The Affordable Care Act Dinah Riveron HCS/455 May 18, 2015 John Cutspec Policy Process: The Affordable Care Act The Patient Protection and Affordable Care Act signed by President Obama on March 23, 2010 as the means to enforce Health Insurance reform. Its main object is to make Health Insurance and Preventive care accessible and affordable to the American population. The Affordable Care Act The ACA major components include: Medicaid expansion, allowing states the opportunity to expand their existing Medicaid programs to include, (OPA, 1015) “individuals under 65 years of age with incomes up to 133% of the federal poverty level… (as well as) certain low-income adults without children” (Medicaid Expansion). Health Insurance Marketplace (HIM), available for access to individuals and small businesses enabling them to compare a variety of plans on the basis of price, quality and benefits and to choose the most affordable option according to their needs. The proposed three models are State Operated, State and Government Operated, and Federal Government Operated, for States that choose not to establish a program. Under the ACA, health services provided by all Insurance companies (participating or not on the HIM) are required to offer individuals and small businesses, affordable health Insurance plans that allow access to ten services identified as Essential Health Benefits (EHB). EHB services include, Ambulatory and Emergency services, Hospitalization...
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...N395 Short Answer 1 – PPACA Changes for Medicare Enrollees May 25, 2012 In 2010, “Covering Preventative Health Services” was implemented and mandated that all new insurance plans must cover preventative services at no charge by exempting these benefits from deductibles. Before this change, most preventative services had cost-sharing requirements. In 2011, these vaguely free services would be further defined and expanded for Medicare enrollees. In 2010, Medicare also began covering smoking cessation counseling services in outpatient and inpatient settings. Although Medicare enrollees were charged a copay for this service, smoking cessation counseling services began to be offered annually with no cost in 2011. In 2011, the PPACA implemented “Improving Medicare Preventative Health Coverage,” which began to focus more on preventative services by creating a free, annual wellness visit and offering personalized prevention plan services. This wellness visit is offered to patients enrolled in Medicare Part B for one year and can be repeated annually. The available preventative services that are offered to all Medicare enrollees are the following: annual bone mass measurements (DEXA scan), annual cardiovascular disease behavioral therapy, cardiovascular screenings every five years (lipid panel), various colon cancer screenings, annual depression screening, a one-time EKG screening, annual influenza vaccine, a one-time pneumococcal vaccine, annual mammogram, two general preventative...
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...covered or seek private insurance. Mandatory physical exams and blood work should be discussed in detail at employee forums and human resources should not just assume all employees know their coverage rights. Physician’s office staff should be well educated in insurance literacy to let their patients know what their coverage rights are. This will keep the patient from getting a surprisingly high statement in the mail. Those who are eligible for Medicare should not have deductibles. If they are on Medicare then they obviously fall below some standard and therefore do not have the money to pay for medical coverage. Carla states, “Medicare should not be eliminated unless the federal government is going to hand out free healthcare coverage to the elderly.” According to the Future of the Affordable Care Act (ACA), as part of the Medicare Modernization Act that occurred in 2003, Medicare Plans were reduced to lower reimbursements. The goal was to have more beneficiaries seek private insurance, more cost effective and efficient than Medicare. The Government...
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...Finance 4510 Exam Two Directions: Pick 10 questions and do a very good job of answering the questions. Essay Questions, not short answer. Reference each question, where you found your answers. Run a spell and grammar check. Discuss the uses of Life Insurance and explain how you would determine how much life insurance a family would need. Discuss the use of Disability Income Insurance and explain how you would determine how much disability insurance an individual would need. Name a category of individuals who might benefit from Disability Income Insurance. Explain why this category might need Disability Insurance. Discuss the use of Property and Causality Insurance and how this is used by a family or individual. Property and casualty insurance is insurance that protects against property losses to one’s business, home or car and against legal liability that may result from injury or damage to the property of others. This type of insurance can protect a person or a business with an interest in the insured physical property against losses. Auto Insurance policies typically cover you and your spouse, relatives who live in your home and other licensed drivers to whom you give permission to drive your car. The policy provides coverage for both bodily injury and property damage liability as well as physical damage to your vehicle. Auto insurance typically covers personal injury, medical payments, uninsured motorist, underinsured motorist, auto rental, emergency road assistance...
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...Medicare and Medicaid are both government-sponsored programs designed to help cover healthcare costs. While both were established by the U.S. government in 1965 and are taxpayer funded, they are actually very different programs with differing eligibility requirements and coverage. Medicare is designed to help with long-term care for the elderly, while Medicaid covers healthcare costs for the poor. Medicare is a federal program attached to Social Security. It is available to all U.S. citizens 65 years of age or older and it also covers people with certain disabilities. It is available regardless of income. Medicaid is a joint federal and state program that helps low-income individuals and families pay for the costs associated with medical and long-term custodial care. The federal government funds up to 50% of the cost of each state's Medicaid program, with more affluent states receiving less funding than less affluent states. Because of this federal/state partnership, there are actually 50 different Medicaid programs, one for each state. Unlike Medicare, which is available to everyone, Medicaid has strict eligibility requirements. Medicaid is often used to fund long-term care, which is not covered by Medicare or by most private health insurance policies. Medicaid is the nation's largest single source of long-term care funding. Medicare and Medicaid programs work together to provide medical coverage to elderly and poor people. Medicare is the primary medical coverage provider...
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...On March 23rd 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into effect. This legislation was created to reform the American healthcare system, protect patients, and to provide insurance for more people in our country that could not previously afford or receive it. Since the Affordable Care Act has been passed, it has created uproar in our country. Many people in our Country do not want to be forced to purchase a healthcare plan created by the government, others don’t want to pay the increased taxes that have been enacted to help fund the new healthcare act. However, when it comes down to it, our healthcare system needed some change. The insurance companies had too much power; they could refuse to cover someone based on the most miniscule pre-existing condition. For the U.S. being the wealthiest country in the world, our healthcare was nowhere near the top in the world. There was a huge amount of fraud and waste going on in medical facilities across the nation, which was leading to increased unnecessary costs and overall inefficiency. The Affordable Care Act wont fix all of these problems right away or maybe even years down the road, but at least it is a step in the right direction and is putting methods into action to fix our healthcare system. The following policies are my three favorite policies of the Patient Protection and Affordable Care Act. One of my favorite policies of the Affordable Care Act is that it will prevent insurance companies...
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...HMGT 6320.501 – The American Healthcare System, Briefing Paper- 2 Name: Dilpreet Singh What is Medicare? What are the components and how are they financed? What are the problems facing Medicare? What are your solutions? Medicare: Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Administered by the US government since 1966, Medicare is currently using 30 private insurance companies across United States. In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and 8 million younger people with disabilities. On average, Medicare covers about half (48 %) of the health care charges for those enrolled in Medicare. The enrollees must then cover the remaining approved charges either with supplemental insurance or with another form of out-of-pocket coverage. Components of Medicare: Medicare has four parts. These different parts help cover specific services. Medicare PART A (Hospital/Hospice Insurance): Part A covers inpatient hospital stays including semiprivate room, food, tests, care in a skilled nursing facility, and hospice care. (Hospice care focuses on palliation of seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs) Medicare PART B (Medical Insurance): Part B medical insurance covers certain doctors' services, outpatient...
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...HCM549 WS5 Questions 1. What is the main source of funding in the U.S. for health care services? The main source of funding for healthcare in the US is the people. Though there is funding from the government; the funds ultimately come from the people through tax money. 2. What are some of the factors that affect the health status of people? Include at least two access (to health services) related factors and two non-access (to health services) related factors. Access to preventative care and quality of provider care are two access related factors. Non-access related factors are misdiagnosis due to incorrect coding and high insurance cost resulting in lack of care. 3. In what ways can good leadership and management control health care costs? Proper management of data and information can control costs. The National Committee for Quality Assurance (NCQA) developed the Healthcare effectiveness Data and Information Set (HEDIS). HEDIS relies principally on administrative data to measure six dimensions of prepaid managed care plans: quality management, physicians’ credentials, members’ rights and responsibilities, preventive health services, utilization management, and medical records. 4. How are quality issues affecting facilities? Two national organizations that monitor quality of care are the Joint Commission and the NCQA. Participation in the Joint Commission is voluntary, but states may link their facility licensure requirements to Joint...
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...Health Care Museum Introduction From the 1900’s to the 2000’s health care in America has changed significantly. Many people believe it has changed for the better, while some feel it may have changed for the worse. Over the years hospitals and other Healthcare facilities have become more scientific organizations. More and more, people are recognizing their need for Healthcare and the importance it plays in their lives. My Museum Hall of Fame will focus on the changes in Health Insurance and its many different policies. The depression in the 1930’s changes Healthcare with Employer-Based Health Insurance, which made health insurance much more accessible to working, middle-class Americans. By the mid 1950’s 45 percent of the population had health insurance coverage. Coverage then skyrocketed and by 1963 about 77 percent of people were covered by some form of Health Insurance. It seems Commercial-Based Insurance companies may have put an end to Employer-Based Insurance, but may have opened the door for insurance to improve and grow in other ways. Development Description Analysis (How does the development affect the current U.S. health care system?) 1. Employer-Sponsored Health Insurance During World War II the federal government controlled employer’s wages, forcing employers to search for another way to attract and hold onto workers. The labor market was suffering because of the increased need for goods and the decreased number of workers during...
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...Analysis Heather Horning HCS/550 August 18, 2014 Elaine Bobo Budgetary Analysis The Medicaid program is one of the largest sources of health insurance in this country in addition to employer-based health insurance and Medicare. Medicaid delivers crucial medical related services to the most at risk populations in society. The importance of Medicaid's part in providing health insurance cannot be exaggerated; “the Medicaid program covers millions of low-income women, children, elderly people and individuals with disabilities” (U.S Department of Health and Human Services, 2000). Funding for Medicaid is limited through various federal policies, leaving much of the program’s budget burdened on the individual states to make necessary spending cuts in order to provide the funds needed for the demand of the program. Budgetary decisions need to be thoroughly reviewed before any immediate action is taken as these decisions can create a domino effect on other programs and their participants as sections of this paper will describe. Medicaid Overview Medicaid is a cooperative federal and state program with a common goal to provide a vital service for the general public. “Medicaid is the largest source of federal revenue for states. Medicaid funds support health care providers, jobs and state economies overall” (Kaiser Family Foundation, 2013). Every state institutes its own eligibility criteria, benefits platform, payment rates and program organization under the broad federal recommendations...
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...outsourced to private businesses. Like anything performed by any business, organization or government body, there are potential improvements that could be implemented. Here, I will discuss the stakeholders involved in the federal healthcare systems of Medicare and Medicaid, and how the strategies might be improved within outsourcing practices. Multiple groups hold interest in the strategies used by Medicare and Medicaid to provide healthcare to patients. Medicare contracts with private health insurance companies to provide specific benefits to people with Medicare. People eligible for Medicare include those over 65 years old, or those who are disabled. Medicaid is operated at the state government level, and generally covers disabled, and people over 65 years old with low income and minimal assets. In addition to the people covered under these systems, additional stakeholders include doctors, hospitals, insurance brokers and agents, and public policy-makers (legislators). An easily forgotten group of stakeholders within these systems are taxpayers not currently receiving direct benefits from these systems, but who are directly contributing funds which are used to fund Medicare and Medicaid expenditures. Those who are recipients of Medicare and Medicaid benefits want to receive the best possible care, with the least amount of cost to them personally. Meanwhile doctors and hospitals want to receive the highest possible amount of reimbursement for their services, facility use and time...
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...Is Medicare Sustainable? Brian Arguello Grand Canyon University: HCA 530 Introduction to Health Care Finance June 8, 2016 Is Medicare Sustainable? Medicare has been the primary health care provider for people over the age of 65 or disabled Americans for over 40 years. The program is in constant change because of new medical technology, advanced delivery systems, and rising costs. Despite the program being in continual transformation, many believe that Medicare is in need of major reform. The obvious question to be asked is, what is the future of Medicare and is the program sustainable? Assessing Medicare’s financial status is straight forward. Looking at Medicare parts A, B, and D individually, one can actuate whether the claims for each part can be paid, making the financial status an actuarial issue. Keep in mind that sustainability and financing are different. A program may be sufficiently funded but not sustainable, making the question of sustainability difficult to assess. According to Foster and Clemens (2009), “Sustainability for Medicare is a judgement about whether the program, as currently constructed, will meet the demands of all affected parties today and in the future” (p. 85). It is important to assess the program on its abilities to meet the needs of the patients and healthcare organizations but cost and future costs are the biggest concerns for all involved parties. The sustainability is of interest to both for-profit and not-for-profit healthcare...
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...Health Care Spending in the United States Lisa Patti HCS/440 April 23, 2012 Caryn Callahan Introduction Heath care in the United States is costly and confusing. Many do not follow the facts, policies or cost the government has controlled in health care. This leads to obtaining the incorrect insurance that causes high out of pocket expenses to choosing no health insurance at all. In today’s society many cannot afford health insurance, in 2010 49.9 million people in the United States were without health insurance (Overview of the Uninsured in the United States: A Summary of the 2011 Current Population Survey, 2011). The issues that will be discussed are the level of current nation health care expenditures, whether spending is too much or not enough, where the nation should add or not, and why, and how the public’s health care needs are paid for and financed by various payers. The current level of national healthcare expenditures U.S. health care costs have risen rapidly in the past few years, imposing increased stress on families, businesses, and public budgets. Health spending is increasing more rapidly than the economy and workers' earnings. In recent years, insurance administrative overhead has been rising faster than other components of health spending, while pharmaceutical spending has increased more rapidly than spending on other health care services (The Common Wealth Fund, 2007). The national health care expenditure is a total amount spent in the United States...
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...CARE MUSEUM The following paper is a proposal for the new Health Care Hall of Fame Museum. The Museum will be composed of five exhibits, which are Medicare, Modern Health Insurance, Hospice, Long term care and the Public Health service. The first part of this proposal for the museum will discuss the history and impact of these health care developments on the health care system. The second part will be an overview of how these five exhibits relate to each other in the health care system. Medicare Exhibit 1 As part of the Social Security Act the Medicare Program was signed into law on July 30, 1965 by President Johnson. This program came into place because Americans over 65 could not get insurance. Created in the 1960 it was based on the private insurance system that was in use at the time. Administered by the Centers for Medicare and Medicaid Services (CMS) Medicare is purely a government program Austin and Wetle (2012). Over the years there have been many changes to Medicare to keep it relevant with the changing times for example, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. People can become qualified to receive Medicare by three different ways, be over the age of 65 and eligible for Social Security benefits, be permanently disabled, or have an end-stage renal disease. Medicare brought the government into health care insurance business. Before the program it was hard for people over the age of 65 to get health...
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