Medicare Financing, Eligibility and Benefits
- Details
- Hits: 18582
Medicare
Medicare is national social insurance in the United States with establishment since 1966 by the federal government, using several private insurance companies to administer (Kaiser, 2010). The system provides cover for people over the age of 65 years who worked and paid for the cover, young people with disability and those diseases as per the determinations that other providers do not cover. Some of the diseases covered under the plan are end stage renal disease and amyotrophic lateral sclerosis. The insurance has grown to include over 50 million people with about 80% of those covered being those above the age of 65. The cover has also become a mega-primary payer for inpatient services hitting close to 50% of the total aggregated pay.
Financing Medicare
The federal government is the primary source of finance for Medicare with the enrollees handling a set premium and supplementary payment for some services. The contributions would depend on the level of the cover a person is and the service delivered to the individual with a possibility of the contributions varying per individuals (Newhouse, 2010). In short, the program shares cost with an individual and each person has to contribute a premium and settle an out of the pocket requirement for the service delivered. A premium is an amount a person pays on a monthly basis for the insurance plan whereas deductible is the amount a person pays as a share of the cover on the service rendered (Kaiser, 2010).
Deductibles and premium are not often the same for individuals and can vary each year as the amounts are usually published by the agency administering the plans before the financial period ends (Kaiser, 2010). The insurance coverage is in four parts, and the monthly premium and the deductibles differ for the individuals in those groups due to the extent of coverage. In case a person or the spouse over the age of 65 paid the premium or the spouse previously made the payments, the beneficiaries are less likely to pay the monthly premium after the age of 65. It is worth noting that less than a tenth of the total beneficiaries under category A of the plan pay a monthly premium for the cover (US, 2014).
For those who do not qualify for the premium free cover, they have to pay $407 every month for the plan. Part A insurance covers all medical expenses for an individual excluding deductible or coinsurance, which varies depending on the hospital length of stay (Newhouse, 2010). For those who will spend up to 60 days in the hospital, the plan will take care of all the expenses and an individual will not pay a deductible. Similarly, for coinsurance, individuals who spend more than 20 days in a hospital must pay a certain amount to cater for the skilled nursing facility. Unlike part A plan that focus on the previous contribution in terms of tax, part B has a monthly premium set by the administering agency each year.
This plan has penalties that individuals accrue for late enrolment or re-enrolment, and the total amount is distributed across the year raising the single premium. However, persons who had previous coverage are not eligible of paying a penalty in case their insurance plan expires and opt to join the Medicare program (US, 2014). In plan B, the amount of household income also determines the amount of premium a person has to pay with those of higher income paying more as compared to their counterparts with lower income. Plan B also has a deductible rate similar to that of plan A but with a co-insurance of 20% of the total medical expenses incurred, though there are free benefits provided to a person where there is no requirement for extra pay. Part D plan is drugs prescription coverage and has penalty applicable for late enrolment similar to that of plan B.
Eligibility and Benefits
As discussed in earlier paragraphs, those above the age of 65 and children with a disability qualifies for cover under Medicare plan. There are also identifiable diseases and conditions that other insurance cover providers do not enroll, and thus the system provides coverage if the beneficiaries receive social disability insurance benefit (US, 2014). Therefore, it is worth noting that those over the age of 65 citizens or legal residence for over five years with themselves or their spouse having paid Medicare taxes for ten years or more. Those below the qualifying age, but with disability qualify for the cover if they receive disability insurance benefits for at least two years. Finally, those who qualify for the social security disability insurance or with conditions qualifying for the plan are also eligible (Newhouse, 2010).
The four parts of the plan have different benefits for individuals with part A covering hospital insurance, part B covering medical insurance, part C including health plans and part D for pharmaceutical prescriptions. Those enrolled in part A receives hospital coverage including stay, food, and rehabilitation in a skilled nursing facility (Newhouse, 2010). Part B ostensibly provides cover for those services not covered in part A and focuses on outpatient services. Apart from the outpatient procedures under the cover, the beneficiary also gets to benefit from durable medical equipment (US, 2014). Part C is commonly considered a combination of A and B with the beneficiaries considerably getting the advantage as those of health management plans. Part D gives cover for drug prescriptions and pharmaceutical products for the recipients.