Medicare Essay

1958 words - 8 pages

TAKE HOME EXAM --QUESTION #1:
Medicare and Medicaid share many similarities and have many differences in terms of the populations that are eligible for benefits; the general benefits or services covered; and how the programs are funded and administered. Furthermore, a closer inspection of Medicare reveals both strengths and flaws in the program.
Medicare, otherwise known as Title 18, is a federal program that provides healthcare for all those who are 65 years and older. Anyone 65 and older who qualifies for Social Security is automatically eligible for Medicare. In addition, Medicare covers those who are permanently disabled, as well those with kidney failure (end-stage renal disease, ESRD). (Barr, 2007)
All those who qualify for Medicare qualify for Medicare Part A and B. Under the Part A plan which is universal for all seniors receiving Social Security, the government pays for all hospitalization-related costs for 60 days. Benefits include hospice care, skilled nurse facility following hospitalization, and hospice care for terminally ill people. (Barr, 2007)
Funding for Medicare is primarily drawn from three sources: general revenues (40 percent), payroll taxes (38 percent) and premiums paid by beneficiaries (12 percent). (Foundation, 2010) Funding for Part A comes from a 1.5 % payroll tax levied on all workers and employers which is then deposited into a Hospital Insurance Trust Fund. The money paid into the Medicare Trust Fund is not used by those who are contributing to the fund but by those who are already retired. In essence, current workers are subsidizing for those who are retired. Nevertheless patients enjoying the benefits of Part A are still expected to pay a deductible unless they purchase supplementary Medigap Insurance. The government does not pay bills submitted by hospitals but instead contracts companies known as “fiscal intermediaries” to reimburse hospitals from the Medicare trust fund. (Barr, 2007)
Medicare Part B pays for doctor fees and other medical costs for care provided outside the hospital like services provided by x-ray offices and laboratories. (117 Barr) Physicians who choose to accept Medicare patients agree to receive an amount dictated by Medicare as payment in full for the service provided. Typically, this is about two-thirds of the fees the physician usually charges. Medicare is responsible for 80 % of that fee and the remainder is paid for by the patients. Those in Plan B have consented to have their premium withheld from the Social Security checks. Unlike Part A, this is voluntary and thus seniors have the choice to elect out of this program. (117) (Barr, 2007)
Part C known as Medicare Advantage (MA) provides Medicare beneficiaries the option to receive their health services through the private sectors. Finally, Part D is the prescription drug plan but those who have subscribed to MA, gets this coverage through MA. (Foundation, 2010)
While Medicare (Title 19) is both funded and...

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