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History of Medicare Advantage
Benefits provided by Medicare
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Medicare is one of the largest health insurance programs running in the United States, and its efficiency is due to several aspects. Application forms and the entire enrollment process are conceived to be as simple as possible and accessible too. But the main quality that makes Medicare so efficient and satisfying is represented by the benefits one can get after enrollment. Another appreciable feature is that Medicare considers automatically eligible all American citizens with the age of 65, but also accepts as beneficiaries of the insurance people which are not yet 65 experiencing some severe disorders, and foreign citizens who have worked in the United States for an established period of time.
The basic programs developed by Medicare are
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However, Medicare part A and Medicare part B do not cover prescription drugs expenses automatically. This is why Medicare had designed a different part to deal with prescription drugs coverage, that is, Medicare part D.
What is then Medicare part C? This part is often referred to as Medicare Advantage plans. It was designed as a more flexible strategy of handling health insurance issues. Some people prefer to receive their benefits through their private health insurance plans, instead of through the original Medicare plan that consisted of parts A and B. Because people were offered the possibility to choose how to receive the benefits, part C, or Medicare Advantage plans, was also named "Medicare + Choice".
Medicare Advantage plans include Medicare Health Maintenance Organization (HMOs), Preferred Provider Organizations (PPO), Medicare Special Needs Plans and Private Free-for-Service Plans. Each of these plans has its own way of handling insurance issues and works differently. But the main condition they all have to meet is that the insured must have Medicare part A and B, otherwise they can not benefit from Medicare Advantage
Kaiser Permanente’s mission is to provide care assistance to those in need. As a health maintenance organization, Kaiser Permanente provides preventive care such as prenatal care, immunizations, diagnostics, hospital medical and pharmacy services. Also, they take responsibility and provide exceptional training for their future health professionals for better clinical performance and treatment for the patients. The organization is to ensure fair and proper treatment towards their employees for a pleasant working environment in hospital and to provide medical services especially in a growing population in suburban communities, such as Tracy and Stockton in California.
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.
(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.
There are several issues concerning the uninsured and underinsured patient population in America. There are many areas of concern the congressional efforts to increase the availability of health insurance, the public image of the insurance industry illustrated by the movie "John Q", the lack of good management tools, and creating health insurance coverage for all low income Americans. Since the number of uninsured Americans has risen to 43 million from 37 million in the flourishing 1990s and could shoot up even more severely if the economy continues to decrease and health care premiums keep increasing (Insurance No Simple Fix, 2001).
It covers ambulatory care and physician fees. There is a deductible and there are sometimes co-pays as well. Part C is presented as an alternative to Parts A and B. This is where private insurance companies can contract with the federal government to offer Medicare benefits through their own policies. It can offer benefits not covered under original Medicare, although there might be a premium charged.
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)
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 provides healthcare coverage for individuals over the age of 65, in addition, to others meeting certain criteria. The government funds Medicare through the administration of the federal Centers for Medicare and Medicaid and spends billions annually, on the program. Fraud runs rampantly throughout the healthcare program due to the enormous amount of money spent and the large number of people enrolled in the program. Fighting fraud of this nature necessitates diligence by everyone. Protecting oneself entails understanding what constitutes fraud, identifying it, noting suspicious practices, and taking steps towards prevention.
These requirements overlap between the two and some beneficiaries do qualify for both benefits. This means that Medicaid is sometimes used to help pay for Medicare premiums and those who do quality for both programs are considered to be “dual eligible” and will usually enroll in both programs in order to cut personal costs. Medicare and Medicaid both have their financial woes, each have their burdens, a...
From the baby Boomer generation, to the young adults just entering the work force for their first time, everyone will have the opportunity to access health care, some for the first time in their lives. Obama Care is an affordable choice for those who need it. When choosing a plan that is right for you, several options are available. “The marketplace allows individuals and small businesses to compare health plans on a level playing field.” (Key Features of ACA by year) With these baseline individuals are able to pick a plan, which is affordable for their lives. In addition to those who select their coverage, there is a separate plan for the population of Americans who are 65 years or older. This plan is known as Medicare. As with every insurance company, Medicare has separate breakdowns plans, to which coverage is not determined by your income. Medicare is an insurance plan for the baby Boomer generation. Robert B. Reich addresses the baby Boomer generation in his essay “Why the Rich Are Getting Richer and the Poor, Poorer” In the essay Reich was able to address the growth of our nation as a metaphor of boats rising and falling. This quote describes how workers in the twenty first century will be responsible for the Baby Boomer’s standard of living. He
Medicare is a federally governed insurance program, primarily serving Americans over the age of 65, younger disabled meeting specific disability criteria, and dialysis patients having permanent kidney failure. Medicare is linked to Social Security, is not income based, and is available to every American meeting the requirements of the program. Those entitled to Medicare can select Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) paying co-insurance and deductibles or opt to add Part C (Medicare Advantage Plans) paying a monthly premium and co-payments normally less than the out-of-pocket expenses for Original Medicare.
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.
Access to health care refers to the ease with which an individual can obtain needed medical services. Many Americans face barriers that make it difficult to obtain basic health care services. These barriers to services include lack of availability, high cost, and lack of insurance coverage. "Limited access to health care impacts people's ability to reach their full potential, negatively affecting their quality of life." (Access to Health Services, 2014) Access to health services encompasses four components that include coverage, services, timeliness, and workforce
...ue to numerous medical errors. With the amount of medical errors that currently do occur which is a current health care issue it cost the health care billions of dollar each year to fix the mistakes that were made.
Health care has always been an interesting topic all over the world. Voltaire once said, “The art of medicine consists of amusing the patient while nature cures the disease.” It may seem like health care that nothing gets accomplished in different health care systems, but ultimately many trying to cures diseases and improve health care systems.