The Medicare program is for an individual who is at least 65 years old, under 65 and disabled, or any age with permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). It also requires that the person is a U.S. citizen or has been a legal resident for five continuous years and has paid into Social Security for at least ten years and is eligible for the benefits. Medicare helps those people with the cost of health care, but it does not pay for all medical expenses or the cost of most long-term care. There are four parts to the Medicare program. Part A is the hospital insurance which helps pay for the in-patient care at a hospital or skilled nursing facility following a hospital stay, some in- home health care and hospice care.
Medicare is a Federal Government program designed to cover people age 65 or older, people with certain disabilities and serious kidney failure. Within this program, there are four sub divisions also called “parts”. • Part A - cover hospital insurance such as hospital stays, nursing facilities, supplies, etc. • Part B – cover Supplementary Medical Insurance such as physician and nursing services, home – health services, outpatient visits. This part carries a deductible and a monthly premium.
Healthcare Financing Medicare was created in 1965 as a way to provide affordable health care to qualified United States residents age 65 and older. In addition to the age criteria, a person can quality for Medicare if they are disabled and receiving Social Security benefits for at least two years or have End Stage Renal Disease. Since the majority of the costs are paid by the working citizens in the form of payroll taxes called Federal Insurance Contributions Act, the insured is not responsible for the premium costs. Part A and B were two parts of Medicare originally but now the program has expanded to four parts. The author will discuss the differences in Parts A, B, and D. Medicare Coverage Part A Medicare Part A is often called the hospital insurance because the coverage is primarily directed at hospital services.
Health care delivery is the relationship between patients and providers (Shi & Singh, 2012). These third-party payers include private insurance companies; manage care organizations (MCOs), government programs (Medicare, Medicaid, etc.). Third-party payers provide medical coverage from individual from high to low income families and individuals. However, today many Americans are uninsured. According to Shi & Singh (2012), reports showed that 1 in 3 or 87.6 million Americans were uninsured between 2008 and 2009 under the age of 65.
Individual health insurance is where individuals pay premiums, and the insurance company pays for certain health-care costs covered in the policy. Most non-elderly Americans with private health insurance receive it through their employers, nearly all of whom pay at least half the premiums. Individuals must pay all premiums for individual health insurance. In most states, premiums vary by age, and most states allow insurers to medically underwrite applicants. Some states sponsor high-risk pools for people who cannot get coverage on the open market, though premiums can be high.
It is a system that relies on private companies to provide health insurance, on individuals to provide financing for it and on a mix of public, subsidized and private hospitals, other health care institutions and physicians that provide services. The federal and cantonal authorities get involved when the private sector cannot meet its obligations and this intervention has been increasing in the past decades, meaning growth of public health care. It is mandatory for all people to purchase basic health insurance, either after three months of living in the country or at birth. Insurance has to be purchased by each individual, including dependents and is not paid by employers. Insured individuals have the choice of selecting from competing insurance companies that are authorized by the Federal Act.
Most people have a managed healthcare plan through an employer or self employment. Premiums are paid on the insured’s behalf for the purpose of covering healthcare costs. The two major healthcare plans are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). Health Maintenance Organization (HMO) is an organization that provides healthcare coverage through hospitals, physicians, and other providers which are contracted by the HMO; this type of insurance coverage only pays for services rendered by physicians and other providers who are within the network and have agreed to treat patients according to the guidelines of the HMO contract. The HMO plan is usually less expensive because the patient is limited to certain providers.
Moreover, hospital emergency departments (EDs) are the only part of the health care system that is required by federal law to provide care to all patients, regardless of ability to pay. A sizable number of patients who visit the ED do not require the level of care that an emergency room provides. In some states, for example, patients with non-urgent medical problems account for over 40 percent of ED visits. Emergency rooms are constantly filled with increasing numbers of uninsured Americans and enrollees in public programs. They find their overcrowding further aggravated by outdated federal and state policies (Brewster, 2007).
Redefined Health Care The health care system in the United States can use a great deal of work. The US health care ranks 37th in the world based on fairness and quality. In 2010 almost 49 million American had no health insurance. In the US most health care is provided though managed care like a health maintenance organization (HMO) or preferred provider organization (PPO). Managed care is, “a system for providing care to particular group of patients, using regulatory restraints to control costs and increase efficiency.” They typically receive this care through different providers.
* Identify key macroeconomic variables that affect your industry. * Consumption- in today’s society the health care industry provides health care services to individuals by * Output- * Unemployment/ uninsured- * The health care industry is affected by individuals not being covered by insurance. This results in people who really needing health care services and not being able to pay for them. If individuals are laid off or not working they may not have the disposable income to pay for treatment, medicines or other services provided. Health insurance plans pay doctors, hospitals and other providers in various ways such as fee for service, bundled payments or a fixed amount for all services that a patient may receive over a period of time.