Essay Sample on Analyze the Different Aspects of Medicare Programs

Published: 2023-01-26
Essay Sample on Analyze the Different Aspects of Medicare Programs
Type of paper:  Research paper
Categories:  Analysis Medicine Healthcare policy Public health
Pages: 7
Wordcount: 1880 words
16 min read

The purpose of this project is to analyze the different aspects of Medicare programs and how they use different programs that can help people to achieve their health goals. The main focus is on the costs of healthcare and how the services are delivered. One of the areas considered is the payment of prescription drugs and how this affects the effectiveness of the Medicare programs. The high costs of drugs vary from one place to the other, and there is a need to have a better way to balance the costs to reduce the inconsistencies.
Keywords- Medicare, Drug Costs, Chronic Diseases.

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Health is one of the major concerns for any government, and it is the mandate of the federal government to ensure there are adequate programs to assist citizens in having access to affordable healthcare. Medicare is a national health program that covers hospital expenses, rehabilitation services, emergency services, nursing services, and the cost of prescription drugs. Medicare is divided into four main types; A, B, C, and D [1]. Part A is also known as hospital insurance, and it is the basic healthcare coverage that includes professional nursing care services, and inpatient medical services. The cover is given at a low cost or for free to all Americans aged 65 years and above and those who are turning 65 soon. The cover also includes home care costs. Part B is also known as medical insurance and it covers outpatient care and doctor care [1]. The coverage includes ambulance services, clinical research, durable medical equipment, health supplies, and preventative measures.

Part C is also known as the Medicare Advantage, and it includes the coverage benefits for parts A and B. It also offers coverage for hospital insurance covered on part A, medical insurance as covered in part B, prescription drugs for part D, and hearing, vision, dental, and health, and wellness programs. Part D, which is also known as prescription insurance, and it covers prescription drugs, and it depends on the plan that one is enrolled to [1]. The above analysis shows that the four parts of Medicare are meant to offer medical relief to the citizens and mostly those who are not rich enough to pay for their medical services on their own. The four parts will be explained deeply later in the essay. One of the main targets of the government is to reduce the burden of paying medical bills and to encourage more insurance usage among the citizens. Chronic diseases are the ones that can persist for over three months, and these include arthritis, asthma, cancer, diabetes, and Alzheimer's disease, among others. Such medications do not just disappear, and they require complex treatments to ensure the patient copes with their symptoms. The prescriptions are costly, and most people cannot afford it. One concern that has attracted many researchers in the United States is how Medicare costs can be reduced without reducing the benefits of the program. The fear of most of the government leaders has been that the benefits that people receive from Medicare are likely to be diluted in the efforts of cutting on Medicare costs. Cheaper Medicare programs for chronic diseases help cut on Medicare costs.

Overview of Medicare in the United States

The current Medicare program does not meet the costs of all chronic diseases, and patients are required to pay from their pockets to sustain their medications. The enrolled Americans in the Medicare programs rely on it to cover most of their medical costs. The costs of medical care are going up each year, and this has attracted a lot of concern in the past. However, the poor management of chronic diseases is one of the main reasons for high Medicare costs. The goals can only be achieved through engagement of the patients in the management process and encouraging them to take part in the prevention measures. The usage of Medicare services among people with chronic diseases has attracted many researchers on the patterns and effectiveness of the programs. Obesity, heart diseases, cancer, and diabetes are among the most prevalent diseases that have high costs of treatment [2]. The diseases above also require consistent and frequent care, which make it expensive and unmanageable for the victims.

Medicare and the Health of the Elderly

The use of Medicare services among the elderly helps them achieve their medical goals related to chronic diseases. Statistics show that chronic diseases are more prevalent among the elderly as compared to the younger population [3]. Cheaper Medicare programs can help citizens to get treatments at a lower cost. One of the major challenges that face the health sector is the political forces and the decisions made by political leaders. Healthcare services are one of the main agendas in the major presidential campaigns and this makes politicians keen on making changes as per their political manifestos. Some of the factors that affect the quality of housing, food security, and transportation. The government concentrates on these aspects at the expense of healthcare services. The idea of Medicare started in the 1930s when President Roosevelt started the efforts to offer health insurance coverage to people affected by the economic depression. The same efforts were done in the 1940s when President Truman pushed for the government to have universal health coverage. In 1965, further changes were made in the social security act by President Johnson and this was to include Medicare and Medicaid for the citizens. By 2016, more than 92% of Americans had health insurance and 17% had Medicaid [3]. The main challenge has been the rising premiums, which makes it necessary to consider having Medicare coverage for all citizens.

Medicare has assisted the elderly to meet their medical costs even after retiring. For those aged above 65 years, one of the major fears they have in life is the inability to pay for their medical expenses. There are many private insurance companies that offer alternative services and supplements to Medicare programs. However, the high cost of the Medicare programs has made it difficult for most of Americans to afford the programs effectively. Medicare part D, which was created in 2006, through the Medicare Prescription Drug, Improvement, and Modernization Act, helped most of the elderly citizens to access drugs under the Medicare programs. Currently, Medicare programs cover about 58 million people and it is expected that it will cover about 75 million people by the year 2027 [3]. For that reason, the federal government is expected to increase the resources set aside for the Medicare programs by 4.1% of the gross domestic product by 2027, from the 3.1% in 2017 [3]. Many citizens will rely on Medicare programs for their daily health care services. It is critical to have a reliable and affordable Medicare system that will meet the needs and expectations of society.

In 1966, Medicare became effective and it covered all elderly people aged 65 years and above, regardless of their demographical differences like race, economic status or gender. Although 85% of the Medicare beneficiaries are aged 65 years and above, the program has expanded to cover people aged less than 65 years. Such people include the people living with a disability, those suffering from chronic diseases and those from poor families [3]. Some of the diseases that guarantee people quicker Medicare coverage include amyotrophic lateral sclerosis and end-stage renal disease. It also covers immigrants who have been in the United States for over 5 years. However, Medicare does not cover routine dental services and vision expenses. Most of the elderly people have challenges related to these areas and this increases the costs of medication. It also does not cover long term care, or when people are on foreign trips outside the US. It covers some of the rehabilitation services that post the acute stage but does not cover long term custodial expenses in the nursing care homes [3].

After the amendments made in 1990, the insurance was standardized and insurers were required to offer the same services to the consumers. The uniform packages were meant to ensure equality among the beneficiaries. The costs of the packages vary with the states, the laws set by the states, and the company with which one registers. The costs are also different among people with disabilities. The elderly can choose to have Medical Advantage (MA), which replaces the parts A and B with a private package and allow them to access and enjoy the other parts, C and D. The drugs' benefits offered in part D reduces the costs significantly for the elderly, because most of them suffer from diseases that require expensive medications [3]. One of the ways in which the government can help the elderly population is reducing the costs of the programs offered. The government can regulate the Maximum Out-Of-Pocket (MOOP) money that people pay. The government can also regulate the extent to which the coverage pays for the services.

The MOOP limits have increased over time. I some places like Durham, the amount is about $4,500 and $10,000, which is way above what most of the retired people can afford [3]. The Medicare programs are a major determinant of the ease with which people get medical services. The number of MA plans has also increased and some of them offer cheaper choices for the enrollees. The main advantage of having MA and the entire Medicare programs is that it helps the patients to access medical services from different hospitals, physicians and specialists as compared to when they look for the services on their own [3]. The government should also increase the literacy level about the available Medicare programs. The programs are not widely known to the citizens and this limits their ability to choose the ones that serve their families best. Some of the programs are suitable for people living with disabilities while others are not. Such literacy is required to ensure the Medicare programs achieve their goals. Medicare costs associated with chronic conditions can be diminished by utilizing cheaper Medicare Programs.

Medicaid Programs and Their Financing

There are several programs that the citizens can enroll to and these are chosen depending on the needs of the people.

Part A

The first one is the hospital and hospice program. It covers the rehabilitation services, hospital care, some home care, and hospice services. For those people who use this program and have worked for over ten years, they do not have monthly premiums. The same applies if one of the spouses has worked for that period. The funding for this program is known as the Medicare Trust Fund [3]. The program is highly suitable for the elderly population and it covers any of the services they require. For the inpatient services, one of the major challenges is the cost of beds per night. Most of the families find it a challenge to meet the high costs of paying for the hospital beds per day. The plan covers the bed and board services. About 20% of the fee-for-service enrollees use this program. The program also pays of the nursing services offered during the stay at the hospital and for the use of the hospital facilities [3].

The latest amendments to the program have also included new coverage that includes the drugs, biologics, appliances, and the therapeutic and diagnostic equipment required. For patients with chronic diseases, the costs of the frequent medical sessions are high and they require such a program. The challenge remains that most of them cannot afford the high costs associated with it and the high premiums.

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