Compare and contrast Medicare and Medicaid
Medicare Benefits Essay
Compare and contrast Medicare and Medicaid; including funding sources, fraud and/or abuse, and eligibility requirements for recipients Both Medicare and Medicaid are administered through a division of Health and Human Services called the Centers for Medicare and Medicaid Services (CMS).
CMS’s primary role is to monitor contractors and state agency to ensure the proper administration of Medicare and Medicaid.
CMS establishes policies for the provider reimbursements, researches healthcare management and treatments, and continually asses the quality of facilities and services. Medicare Benefits Essay
Medicare was created by a Congressional act in 1965 to provide medical insurance to the elderly (those 65 years and older).
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Medicare is a form of the social insurance program that is administered by the government of the United States. The program provides the health insurance covers to senior citizens of the American society aged 65 years and above. It also provides the covers to those people being under the age of 65 but physically disabled permanently or to someone having the congenital physical disability. It further provides the covers for other categories of the groups of people meeting other special criteria, such as the final stage renal disease programs. The Medicare has transformed the lives of many senior citizens that did not use to have the health cover before the formation of Medicare. Therefore, this insurance program is very beneficial to the people of the United States.Medicare Benefits Essay
Medicare is financed from payroll deductions, as a rule. Every paycheck that is received makes its contribution in one or another way to the financial sustain of the Medicare program. The deduction is made on every paycheck. The first deduction made on the paycheck is the FICA, which is termed as a social security tax, and the other deduction is made for the medical purposes. There are a many ways with the help of which this is usually spelt out on the pays’ slip, though in the recent past this has been taken out from the social security item to make it clearer. The Medicare financing is handled by a process of certain percentage of the one’s income being deducted, and the deducted amount is directed to the Medicare kitty to help paying different costs related to it.
The persons eligible for the Medicare program are all those being aged 65 years and above. These persons must legally reside in the USA for at least 5 years. Those persons with disabilities being under the age of 65 years are eligible but if only they receive the social security disability insurance (SSDI) benefits. The persons with disabilities are eligible to receive the Medicare benefits as long as they are receiving the SSDI benefits failure, to which they lose the eligibility to get the benefits from the Medicare (Mark, 2008).Medicare Benefits Essay
The Medicare offers the following benefits to beneficiaries through a number of services that it offers. Firstly, it has the hospital insurance program and covers the patients’ hospital costs, such as food, tests and semiprivate (Davis, 2009). The maximum stay in order for the one to benefit from this program according to the skilled nursing facility is 100 days. The cost incurred in the first 20 days will be fully paid by the Medicare while the remaining 80 days there will be the co-payment. Secondly, it offers the medical insurance, which aids in paying the certain products and services not covered by the hospital insurance cover, especially on the outpatient basis. This cover is not a must if the one of the spouse or beneficiary is still earning (Hellinger, 1998). This program covers the nursing and physician services such as laboratory tests, diagnostic tests, e-rays, outpatient hospital procedures, chemotherapy, pneumonia vaccinations, renal dialysis, blood transfusion, as well as all other outpatient medical services offered by a doctor. Thirdly, it offers the Medicare advantage plans. This is done by private companies getting in the collaboration with the Medicare. The program offers the cover to other health related matters not covered in hospitals and by medical insurance programs.Medicare Benefits Essay
There is a great difference between the premium paid Medicare and the services offered by this program. The premium ones are the payments that the enrollers of the program pay for them to be the beneficiaries in the program at the old age. On the other hand, the services proposed are the benefits that one gets from the Medicare insurance program, such as payments for the hospital bills, as well as for the medication fees (Victoria, 2009).
The Medicare is a program that has transformed the lives of senior citizens of the United Stated to a big extent. Their hospital bills are cared by the program. In addition, the cost of medication is also meet by the program. Therefore, this is a vital program; and all citizens should be encouraged to get enrolled into it as it offers a lot of benefits to the individuals being at the old age.Medicare Benefits Essay
Eventually, Medicare, the nation’s major federal health insurance program, will affect everyone. In fact, if you pay taxes, Medicare already affects everyone because a portion of taxes goes to finance part of the Medicare program. Although you are paying into the Medicare program during your working years, you will probably rely on its services in the future. In fact, persons enrolled for Medicare coverage increased from 19.1 million in 1966 to a projected 38.1 million 1996, a 95 percent increase.
Table 1 – Medicare Enrollment Trends
Total Persons Aged Persons Disabled Persons
One might ask what is Medicare? Well, Medicare is our country’s health insurance program for people age 65 or older, certain people with disabilities who are under 65, and people of any age who have permanent kidney failure. It provides basic protection against the cost of health care, but it does not cover all your medical expenses or the cost of most long-term care. You can choose one of two ways to get benefits under Medicare: the traditional fee-for-service system or the managed care program. The Health Care Financing Administration is the agency in charge of the Medicare program. There are two parts of Medicare. Hospital Insurance (also called Part A Medicare.) Part A Medicare is financed by a portion of your payroll (FICA) tax that also pays for Social Security. The second part of Medicare is Medical Insurance (also called Part B Medicare.) Part B Medicare is partly financed by monthly premiums paid by people who choose to enroll.Medicare Benefits Essay
People are automatically enrolled in Part B when you become entitled to Part A. However, because they must pay a monthly premium for Part B coverage, and have the option of paying for the coverage or turning it down. Each part of Medicare covers different kinds of medical costs and has different rules about enrolling. In order to be eligible for Medicare, one has to meet certain regulations
Pros of Medicare
Medicare Provides Coverage to Those Who Wouldn’t Have Coverage
In many senses, Medicare does “work.” Thanks to the program, millions of aging adults have been able to receive coverage when they otherwise wouldn’t be able to afford it. Prior to 1965, when Medicare was created, around 9 million older adults didn’t have health coverage. That number is significantly higher than the 508,000 seniors who were uninsured in 2018. Medicare also covers many younger Americans with disabilities who, otherwise, would not have healthcare.Medicare Benefits Essay
Consider the implications if Medicare didn’t exist. Older Americans, who typically need the most medical treatment, would find themselves paying exorbitant medical costs directly out of pocket. The total paid every year would be staggering, most likely exceeding their annual income.
Individuals with disabilities would be totally dependent on their caretakers, who may or may not be able to afford medical care.
Medicare is useful because it covers so many people.
Medicare Costs Very Little Every Month
Generally, Medicare enrollees qualify for free Part A but must pay a small, out-of-pocket amount every month for Part B. This number is estimated to cost around $135.50 per month. When you compare this to the out-of-pocket cost of operations, prescriptions, and other associated costs, the savings are huge.Medicare Benefits Essay
Medicare Advantage Plans Offer Additional Coverage
More and more Americans enroll in Medicare Advantage plans each year, and enrollment is expected to keep growing in the future. If fact, enrollment was at 22 million in 2019, quadrupling from 5.3 million in 2004. Part C enrollees made up 34% of the 64 million Medicare recipients as of 2019.Medicare Benefits Essay
MA plans offer beneficiaries an alternative way to get Medicare benefits through plans sold by private insurance companies that contract with the Centers for Medicare & Medicaid Services (CMS).
You get all the Medicare program benefits of Part A hospital insurance and Part B medical insurance, together known as Original Medicare*, when you enroll in Part C (Medicare Advantage). Plus, Medicare Advantage plans may provide additional benefits (dental, vision, etc.) at a minimal cost.Medicare Benefits Essay
These services are essential to older Americans who would suffer otherwise.
Medicare Has Led to Prescription Innovations
The inception of Medicare created a massive market for drug companies. Suddenly, millions of Americans had access to prescriptions they wouldn’t have had otherwise. When pharmaceutical companies saw the untapped potential in the Medicare market, they began investing billions of dollars in the development of drugs tailored specifically for seniors.
