Medicare, Term Paper Example

Introduction

Medicare, a government-sponsored health insurance benefit for older persons in the United States, provides a number of opportunities for seniors to obtain preventative and specialized health services as required. Over 50 million Americans are supported by Medicare either as a primary or supplementary insurance benefit, which includes the provision of prescription drugs, surgical interventions, and physician-related services for these patients (The Henry J. Kaiser Family Foundation, 2012). Medicare is one of the key providers of health insurance in the United States and included approximately 21 percent of all expenditures for healthcare in 2012 (The Henry J. Kaiser Family Foundation, 2012). Also in 2012, expenditures for Medicare were approximately $536 billion (The Henry J. Kaiser Family Foundation, 2012). However, the manner in which Medicare is financed is complex; therefore, funding will be addressed in greater detail in the following paragraphs.

Body

Medicare is funded by several different entities, including two separate trust funds, known as the Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund (Medicare.gov, 2013). The former is financed by payroll taxes and social security taxes, amongst other sources, while the latter is financed by Congressional earmarks and Part B and Part D premiums (Medicare.gov, 2013). The Hospital Insurance Trust Fund is provided as a means of funding Medicare Part A, which supports such services as skilled nursing care and inpatient hospitalizations, along with the costs of managing the Medicare program itself (Medicare.gov, 2013). The Supplementary Medical Insurance Trust Fund supports Part B and Part D benefits, along with the costs of managing the Medicare program (Medicare.gov, 2013).

Specific groups of people qualify for Medicare services and include those persons who are over the age of 65, or under specific conditions, those persons under the age of 65 with qualifying disabilities (Kaiser Permanente, 2013). These persons qualify for both Medicare Part A and Part B, as well as Part D (Kaiser Permanente, 2013). For those with certain disabilities who qualify for Medicare, they are required to have received disability benefits in the past under a specific period of time (PlanPrescriber, 2013). In addition, widows or widowers of disabled persons under the age of 65 may also qualify for Medicare under specific conditions (PlanPrescriber, 2013). Therefore, a large group of individuals qualifies for Medicare and their benefits are regulated by federal governing bodies that are specifically responsible for this level of coverage (PlanPrescriber, 2013).

There are a number of important benefits associated with Medicare and its provisions for seniors and some disabled persons. For example, Medicare provides coverage for most outpatient services and also determines individual out-of-pocket costs for patients, which are generally low (O’Brien, 2013). Medicare Part A provides care and treatment for hospitalizations, home healthcare, skilled nursing care, and hospice services as required (Medicare.gov, 2013). Under these conditions, it is possible for some patients to receive all healthcare services without any out-of-pocket costs, depending upon the services provided and other factors (Medicare.gov, 2013). In addition, Medicare Part D is a prescription drug benefit that provides low out-of-pocket costs for many medications, including formularies that are grouped into different tiers (Medicare.gov, 2013). Under these conditions, it is often the case that patients are able to obtain the required prescription drugs at a lower cost (Medicare.gov, 2013). However, the Part D benefit is not free; rather, a monthly premium is required, in addition to an annual deductible for this plan (Medicare.gov, 2013). Nonetheless, this prescription drug benefit is very useful for those patients who might not otherwise have any type of access to the necessary prescription drugs because they are too expensive (Medicare.gov, 2013).

Finally, Medicare Part B provides coverage for a variety of services, such as doctor visits, routine and specialized testing, supplies, and other offerings that are necessary for patients in treating a specific condition (Medicare.gov, 2013). Therefore, Medicare Part B is divided on the basis of medically necessary and preventative services for those who are covered by this benefit (Medicare.gov, 2013). In these instances, Medicare coverage is determined by the physicians chosen for these services and if they are willing to accept Medicare premiums for the services that are provided (Medicare.gov, 2013). In addition, factors such as state and federal mandates, coverage and service offerings, and other issues are prevalent in determining the extent to which Medicare services are offered to these patients (Medicare.gov, 2013).

Conclusion

Medicare is one of the most important service offerings for senior citizens and some disabled persons in the United States. This provision of health insurance by the federal government supports the ability to access a variety of healthcare services, including hospital-based services, physician-based services, skilled care services, and prescription drugs. Medicare is offered in three different forms and enables individuals to obtain greater access to the health services that are necessary to support health and wellbeing. Medicare is a federally funded program that provides coverage to millions of Americans annually and supports their ability to lead healthier and longer lives. This system has forever transformed the manner in which older Americans receive and utilize health insurance on a regular basis. However, its complexities continue to be challenging for even the most experienced users and demonstrate the need for reform in many areas of this process.

References

The Henry J. Kaiser Family Foundation (2012). Medicare spending and financing fact sheet. Retrieved from http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/

Kaiser Permanente (2013). Medicare eligibility: who is eligible for Medicare? Retrieved from https://medicare.kaiserpermanente.org/wps/portal/medicare/plans/learn/eligibility

Medicare.gov (2013). How is Medicare funded? Retrieved from http://www.medicare.gov/about-us/how-medicare-is-funded/medicare-funding.html

Medicare.gov (2013). Medicare Part A (hospital insurance). Retrieved from http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-a.aspx

Medicare.gov (2013). Monthly premium for drug plans. Retrieved from http://www.medicare.gov/part-d/costs/premiums/drug-plan-premiums.html

Medicare.gov (2013). What does Medicare Part B cover? Retrieved from http://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html

O’Brien, S. (2013). How does Medicare work? Retrieved from http://seniorliving.about.com/od/medicarebenefitsf2/f/medicarefaq1.htm

PlanPrescriber (2013). Medicare eligibility. Retrieved from http://www.planprescriber.com/medicare-eligibility/