Today, Medicare Part D is a most approved federal program celebrated as a government success. It is favored by federal programs in the United States of America and is said to be well under budget. Part D has its own advantages and disadvantages. This paper discusses the various stakeholders and their influence on the outcome of Medicare Part D along with particular strategies and implications that were used to support this Medicare Part D legislation. It also focuses on the specific proposals which can invigorate the program to the low-income subsidy, transition from Medicaid to Medicare, the use of formularies and utilization management tools, Part D and long-term services and supports, and program quality (Kendall, D., 2013, November 05).
In 2006, prescription drug coverage, Medicare Part D became available under Medicare for the first time. In 40 years of history, this program is the most significant change in government health care, offering the potential for improved access to required medications for millions of Americans (Improving the Medicare Part D Program for the Most Vulnerable Beneficiaries, n.d.). The
After Medicare covers up to a certain amount, individual will enter what is called a Donut-Hole in their coverage, which means that they will be paying more out-of-pocket for prescription and health needs (Pros and Cons of Medicare Part D Coverage, n.d.). The implementation of the Part D program was a huge undertaking accomplished very quickly. Unlike other benefits available under traditional Medicare, Part D is administered through almost 1,900 stand-alone prescription drug plans (PDPs). Part D coverage is also available through more than 1,000 private Medicare Advantage Part D plans (MA-PDs) that provide Part A (hospital insurance) and Part B (supplementary medical insurance), as well as Part D prescription drug benefits (Oliver, T. R., Lee, P. R., & Lipton, H. L.,
What is managed care? According to the Oxford English Dictionary, managed care is “a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.” Managed care is a variety of techniques designed to reduce the cost of providing health benefits and advance the quality of care. In the United States alone, there are various managed care programs, that are ranged from more restrictive to less restrictive. As stated in the National Institutes of Health, the future of managed care is uncertain. It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed
(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.
The topic that I am choosing to do is on Obama Care. I chose this topic because the idea of the government forcing people to obtain insurance is wrong in my eyes. I am interested in analyzing the validity for what has been said about this topic in order to increase my understanding about Obama Care. I am not an expert when it comes to Obama Care. I know that this is an insurance that is being provided through the government for the general public. I have read that President Obama never initially read the whole bill itself. I also know that people who cannot afford it, but make too much money to qualify for Medicaid are being heavily encouraged to get this insurance. Some of the common knowledge that I have found that the general public has about this subject is that some people are for Obama Care and think that it is a wonderful idea and that there are some people that are dead set against Obama Care. Younger adults, specifically college age and individuals that are in their twenties tend to be for Obama Care. The insurance is being forced upon individuals that may or may not want it. It also seems as though that the insurance being offered is pretty generic in terms of coverage. Some of the questions that I have that I believe will aide me in writing this paper would be the following: What are the pros and cons of Obama Care? What are the thoughts of Obama Care with the people of the government? As well as what are the basics of Obama Care?
I am terribly ashamed to admit that prior to this class I really did not have a position on the Affordable Care Act (ACA). I simply ignored what was going on because I had insurance through my employer and I didn’t feel like the ACA would have that much bearing on my life. I was aware of some of the positive and negative aspects but had not really given it all a lot of thought. The one thing that did intrigue and interest me was the potential for Medicaid expansion. This was both exciting and troublesome because my job is totally structured around people who qualify for Medicaid. Increasing the rosters would have had a drastic effect on what I do and would have meant tremendous growth for my business but since Tennessee opted not to expand
Part D is the prescription plan for enrollees. Centers for Medicare and Medicaid Services, 2010. Medicare Part A is meant to be a major medical hospitalization plan that is offered to every US citizen that has turned 65 years old. It covers inpatient care in hospitals and skilled nursing facilities, hospice care, some home health care services, a semi-private room, meals and nursing services while in the hospital.... ...
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 has four parts A, B, C, and D. Medicare Part A covers inpatient hospitalization, skilled nursing centers, hospice and some home health services. Medicare Part B covers some services not covered by Part A. Typically there is a premium charged for this coverage. Part B Covers medical supplies and outpatient visits. Medicare Part C, also known as Medicare Advantage plans are offered by private insurance companies which are in contract with Medicare. Medicare Part C provides you benefits from Part A, Part B and usually covers prescription drugs. This plan will cover most services. Last is Medicare Part D, Part D is a prescription drug program offered by private insurance companies. Part D allows drug coverage to the original Medicare plan. (Medicare.gov, 2016)
While most countries around the world have some form of universal national health care system, the United States, one of the wealthiest countries in the world, does not. There are much more benefits to the U.S. adopting a dorm of national health care system than to keep its current system, which has proved to be unnecessarily expensive, complicated, and overall inefficient.
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 IPPS covers patients for 90 days of care per episode of illness, with a 60-day lifetime reserve 2. Episodes begin once the patient is admitted and ends after they have been out of the hospital for 60 days straight 2. During the first 60 days of hospital stay, patients are responsible for a deductible of $1,216 2 while Medicare covers the rest. After day 60, patients must begin copayments, starting at $304, through day 90. After 150 days od care patients are responsible for 100% of costs 2. Comparatively, under the Home Health Prospective payment system (HH PPS), patients are not required to make any copayments for the services provided 4. Home Health care is covered for beneficiaries restricted to their homes and in need of part-time or intermittent skilled care (i.e. nursing, physical, occupational and speech therapy) 4. Instead of 90-day episodes, as in the IPPS, the HH PPS provides care in 60-day episodes 3. Furthermore, after the 60 days ends, a second episode can begin if the patient is still eligible for care as there are no limits to the number of episodes an eligible member can receive
...d has cut down the illegal distribution of prescription drugs. It cuts down on medical costs for the patient by allowing the physician to view what insurance coverage the patient carries for certain medications and. providing lists of similar generic drugs. E-prescribing is just one part of U.S. government’s goal to gradually adopting standards facilitating the shift to all electronic medical records for citizens. Although it has only been available for a short time, electronic-prescribing has already made an impressively large impact on the medical field.
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 and the New Health Care Law — What it Means for You.” (2010). Medicare Publications, http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf
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.
The aging of the baby boomer generation along with the increasing longevity of life expectancies are evolving the demographics of the United States’ society. Older adults account for a much larger percentage of the population than ever before and it is expected that by 2030, one in every five Americans will be eligible for Medicare (Elder Workforce Alliance [EWA], 2012). As Americans are living longer they are also at a greater risk of chronic illness. This shift commands attention and analysis of our current health care system to better meet the needs of this growing population.