...discussing what is Medicare, and what type of impact the Medicare Legislation will have upon it , what changes the Affordable Care Act made to the Medicare program, and last but lest what I feel need to change to the Medicare program that will extended the life program past the year of 2026. Medicare is known as the “national social insurance program, administrated by the United States Federal Government” (Medicare.gov, 2012). Medicare give health insurance to people ages sixty-five (65) years of age and older that have work and paid in to system, and younger people that have a medical and physical disabilities (Medicare.gov, 2012). Medicare when it first started only had two parts that was part A and part B (Longest, 2010). Medicare part A was the Hospital Insurance, better known as HI and it covers hospital visits, home health nurses, nursing homes, and hospice care, and part B which is known as Supplementary Medical Insurance or SMI covers doctor visit, home health services, and other medical services, And then the BBA, better known as Balance Budget Act in 1997 added on a third part which is known a Medicare part C, known as the Medicare Advantage Program pays for most prescription drugs. And there is Medicare Part D which was added by the MMA that pays for the prescription drugs that is not covered by Parts A&B. The Medicare Legislation will have a tremendously impact on the Medicare Program. The Medicare legislation I predict will change the Medicare program for the...
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...EFFECTS ON ENROLLMENT IN THE MEDICARE ADVANTAGE INSURANCE PLANS IN THE STATE OF TEXAS. Medicare is an insurance program provided by the federal government for people who are 65 years old or older, people of all ages with End-Stage Renal Disease, and certain disable people. Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Medicare has become America's leading health care insurance program, providing coverage for approximately 47 million individuals and costing more than $516 billion a year. Medicare nowadays is facing high popularity and an uncertain future. Some experts say that Medicare is expected to go bankrupt in 2017 (Clark, 2009). A Medicare Advantage Plan is another health coverage choice that eligible beneficiaries may have as part of Medicare. The plan is offered by private companies approved by Medicare. MA plans must cover all of the services that Traditional Medicare covers except hospice care. These plans are not considered supplemental coverage but may offer extra coverage such as vision, hearing, dental and/or health and wellness programs. Most include Medicare prescription drug coverage. Medicare pays a fixed amount for the beneficiaries every month to the companies offering the plans. These companies must follow the rules set by Medicare. The motivation to choose this topic comes from an internship or curricular practice training performed during the years 2010...
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...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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...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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...The Cost Of Medicare On The Economy The Cost of Medicare On The Economy Medicare is facing a problem of retiring baby boomers, rising life expectancy, and decreased fertility rates that will increases the proportion of the population over age of 65 who be eligible for Medicare benefits. The problem with Medicare is that they never made adjustments for people who live longer. Also, there are inadequate funds to meet the needs of the future enrollees. Organization Information Medicare is a national social insurance program. It is administered by the United States federal government and was signed into law on July 30, 1965 by President Lyndon Johnson (CMS, 2012). Currently Medicare covers 60 million Americans. The health insurance is available to individuals 65 years and older. It is an insurance program for which these enrollees have money deducted from their pay while they are still working. The health care insurance covers hospitals, physician’s services, nursing home care or home and community-based services Also, the participant pays part of the services called “deductibles”. Medicare provides health insurance benefits to 38.7 million people age 65 years and older. (Center for Medicare & Medicaid services, 2011). Gist of The Problem The problem with Medicare is that the regulations have not changed even though there are more people enrolled in the program. Medicare will be unable to provide the same services unless the premiums are increased. Description:...
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...The Insolvency of Medicare The biggest threat to our country is not global warming, terrorism, drugs and violence or even wars, it is our entitlement programs. The big three are Medicare, Medicaid, and Social Security. Medicare, being the largest, is the health insurance provided for people 65 and older and for younger people with disabilities. The debt that this program alone creates, will transform this country for the worst. With the baby-boomers starting to retire, Medicare spending is expected to skyrocket. Although many feel Medicare is necessary, it is economically problematic for the future of our country. One problem is Medicare’s relationships with physicians are deteriorating. With politicians realizing there are problems, it is easier for them to cut the payments to doctors then to cut the benefits to the patients. Between 2001 and 2010, doctor payments from Medicare have risen only one percent but the physician costs have gone up 22 percent (Childress). According to a 2011 article by Daniel E. Fass, MD, “physicians are in for a 29% slash in Medicare reimbursements this year.” More and more physicians are deciding not to accept Medicare patients. For example, the clinic Qliance decided not to accept both Medicare and private insurance. Only one person is needed to do the billing for 12 doctors. They were able to cut their costs by 40% just by reducing the enormous paperwork and cutting the red tape that held them hostage to the government system (Childress)...
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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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...Essay 1--Medicare Medicare is a social insurance program administered by the United States federal government to guarantee access to health insurance to citizens age 65 and older, those with end-stage renal disease and former workers who have been receiving Social Security Disability Insurance for at least two years. Signed into law on July 30, 1965 by President Lyndon B. Johnson as Title XVIII of the Social Security Amendment of 1965, Medicare was designed to close major gaps in the Old Age, Survivors, and Disability Insurance program (OASDI). Prior to the enacting of Medicare, less than half of the elderly in the US were covered by health insurance. The most significant impact of this law was the establishment of two related health insurance programs to provide protection against the high costs of hospital expenses (Part A), and a voluntary supplemental plan that covers payment for physician services and other medical expenses (Part B). The original budget for Medicare was approximately $10 billion and covered 19 million Americans during the first year. Early legislation to provide a national health plan for seniors was first introduced by President Harry Truman in 1945 when he called for the creation of a national health insurance fund. Every Congress from 1952 to the passage of this bill received proposals, primarily from Democrats, for providing hospital insurance and health benefits as part of the social security system. Medicare Part A, financed by a portion...
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...Medicare and Medicaid reimbursement rate: The payment rates are currently set below the cost of providing care, resulting in underpayment. In 2010, for Medicare, hospitals were paid only 92 cents for every dollar that was spent on Medicare patients. For Medicaid, hospitals received payment of only 93 cents for every dollar spent by hospitals caring for Medicaid patients. Eligibility requirement for Medicaid in CT * Low income children and families * Low income seniors * Disabled * Children with special health care needs What does 100 percent or 150 percent of poverty mean? The federal poverty level represents the level at which poverty or subsistence begins. Each year, the federal government determines this number based on inflation and other relevant factors. The federal poverty level guidelines are used as an eligibility criterion for federal, states and local government programs. 100 percent of poverty mean- an individual or household’s annual income is equal 100 percent of the federal poverty level. 150 percent poverty mean- an individual or a household earns 50 percent more than the federal poverty level. In 2012 for instance, the federal poverty level for an individual was $11,170, so an individual at 150 percent of federal poverty level earned $16,755. How are Medicare and Medicaid funded? Medicare is partially funded from payroll taxes, through the provisions of the Federal Insurance Contributions Act. The Medicare tax rate is currently 2.9...
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...The Future of Medicare Lolita Fields William Carey University NMBA 6920 Medicare celebrated 50 years in 2015. Since being passed in 1965 Medicare has been the source of health insurance for nearly 45 million Americans. According to CMS.gov Medicare has a Part A hospital insurance, Part B medical insurance, and Part D prescription drug coverage. There is also a Medicare Advantage Plan which is called Part C. Today there is a challenge of how to finance care to future generations without burdening the economy or taxpayers. Before we look in to the future lets revisit the past starting with the birth of Medicare. In 1965 President Harry S. Truman proposed a national health care program. He wanted health security for all regardless of residence, station, or race for everyone in the United States. The proposed plan came under scrutiny from the American Medical Association and the bill was not passed. By 1960 the government recognized there was a problem with access to health care for the senior American population. The Kerr-Mills law was enacted so states could receive federal dollars to provide health care for older poor people in the south. By 1963 only 32 states adopted the Kerr-Mills Act and the program proved ineffective because it only reached less than 1% of the senior population. This laid the foundation for Medicare. On July 30, 1965 President Lyndon B. Johnson signed Medicare into law. The principles of Medicare was to provide coverage to all people...
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...Medicare is the United States' health insurance program for individuals age 65 or older. However certain people younger than age 65 can also qualify for Medicare, including those who are disabled, has permanent kidney failure or amyotrophic lateral sclerosis, known as Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. Many Medicare participants must also have supplemental health care coverage in order to cover these charges that are not covered as part of the Medicare program. Is Medicare the perfect program? Well Medicare is financed by a percentage of the payroll taxes paid by workers and their employers. Also this program receives another percentage financed by premiums deducted from monthly Social Security checks. What is this Medicare crisis that everyone fears? The Baby Boomers are certainly growing older and even the youngest of these baby boomers are approaching 50 years of age. Retirement is getting closer but can this generation and the generations following count on the Medicare coverage that the past generations was fortunate enough to receive. Before more money was being saved then what was being spent for Medicare, and that extra money was put into the Hospital Insurance Trust Fund and the Supplemental Medical Insurance Trust Fund. Those funds total about $500 billion, all of it US Treasury bonds. However now thanks to the increasing number of individuals on...
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...Medicare and the Economy In order to fully understand Medicare, we first have to look at how the whole Government program started. To do this, we will first look at Social Security. Franklin D. Roosevelt signed the Social Security Act in August 1935. The first one-time, lump-sum payments were made in January 1937, and regular monthly benefits were first paid in January 1940. (http://www.ssa.gov) Franklin Delano Roosevelt was quoted on August 14, 1935 to say: "This law represents a cornerstone in a structure which is being built but is by no means completed--a structure intended to lessen the force of possible future depressions, to act as a protection to future administrations of the Government against the necessity of going deeply into debt to furnish relief to the needy--a law to flatten out the peaks and valleys of deflation and of inflation--in other words, a law that will take care of human needs and at the same time provide for the United States an economic structure of vastly greater soundness." (http://www.ssa.gov) The act created a uniquely American solution to the problem of old-age pensions. Unlike many European nations, U.S. social security "insurance" was supported from "contributions" in the form of taxes on individuals’ wages and employers’ payrolls rather than directly from Government funds. The act also provided funds to assist children, the blind, and the unemployed; to institute vocational training programs; and provide family health programs. As a result...
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...Medicare Policy Process The health care, policy-making process is composed of three major stages; the formulation stage, legislative stage, and the implementation stage. The policy process refers to the specific decisions and events that are required for a policy to be proposed, considered, and finally either implemented and/or set aside. It is an interactive process with multiple points of access providing opportunities to influence the multiple decision makers involved at each stage (Abood, 2007). Each stage presents a unique set of events for a policy to be proposed, considered, and either implemented or rejected. In the formulation stage there is an input of ideas, information, and research from government officials, citizens, and special interest groups. The issue is framed and the purpose and outcome is defined. Finally strategies are chosen and the necessary resources are identified. In the legislative stage the policy must be discussed by congress, agreed on and signed into law. In the implementation stage the policy is put into effect, human resources and funding are allocated. After a new policy is implemented, advocates, opponents, or other “interested parties” begin to consider the consequences of the decision and its implementation (Cockrel, 2007). Abood (2007), “The overall health care system, including the public and private sectors, and the political forces that affect that system are shaped by the health care, policy-making process” (The Policy Process...
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...Social Security and Medicare History Present Configuration Future Projection GERO100 March 31, 2012 Hopefully we will all be physically able to work until the age of 65, collect retirement and Social Security and live an enriching life until we leave this world. Not all companies financially support their employees with fully funded retirement plans so it is left up to the individual to actively participate in saving for their future. When someone reaches retirement age, if the finances are there, they are usually only a fraction of what they were making as a full-time employee. This is when one hopes of having Social Security and Medicare benefits to supplement our retirement income for a more stable financial future. There are several reasons the Social Security Act was passed in August 1935. The elderly were living longer due to the availability of better health care, autonomy in workplaces to make jobs easier on individuals, and the modernization of our country’s water systems. Due to this increased longevity in the lives of the elderly, they were also more poverty stricken. An intention of the passage of the Social Security Act was to reduce the burden of loss of income to retired workers aged 65 or older. (Quadagno, 2008) It also included provisions for unemployment insurance, old age assistance and aid to dependent children. Benefits were to be paid based on the primary worker and was to be funded through payroll taxes deducted from the worker’s...
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...Medicare Summary Medicare, America’s biggest health protection plan currently covers more than 50 million people nationwide. Medicare can be summaries into 2 major categories, Traditional and Advantage. Both of them have 4 subcategories known as Part A, B, C, and D. Each of them represents a specialty insurance plan; Hospital, Medical/Health, Advantage Plans, and Prescriptions. The Centers for Medicare and Medicaid are responsible for the program operations. Medicare has changed over the years including the legislation law of reform H.R. 3590, Patient Long Protection and Affordable Care Act signed into law in 2010. And then there was H.R. 4872, the Health Care and Education Reconciliation Act. This legislation brings changes and impacts for how the Part D Medicare plans are to enroll and advertise beneficiaries. The legislation protect and strengthen all recipients of Medicare while expanding provisions for low income recipient groups by increasing original Part D provisions. These changes have powerful impact on Part D of the Medicare operations and dynamics that include specialty prescription coverage and benefit design (American Health and Drug Benefits, 2012). There is a plethora of obstacles ahead for the Medicare program; even though the U. S. government’s plan for modification has brought benefits to many, especially for (Over 65) seniors and physically disabled Americans covered by the plan. Revenues are decreasing and the cost of health care is steadily climbing,...
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