Table of Contents
Executive Summary 2
Summary Statement 2
I. Introduction 3
II. About Medicare 4
III. About Medicaid 5
III. Fraud & Abuse of Medicare 7
IV. Fraud & Abuse of Medicaid 8
V. Prevention Program Methods/Reform for Medicare & Medicaid 9
VI. Conclusion 12
References 13
Executive Summary
With the ever-changing difficulties of our health insurance landscape, the government has taken a more active role in the health care and well-being of American citizens. With this shift, programs like Medicare and Medicaid, become polarizing topics in an environment where individual finances are tight, our economy is struggling, and the future is no longer as predictable or financial secure as we once believed it to
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Most individuals that are covered under Part B pay a monthly premium. Part B of Medicare fills the gaps that the original Medicare coverage does not pay.
Medicare Part C, also known as Medicare Advantage Plans, allow individuals to supplement or customize a plan that aligns with their personal medical needs. “These plans enlist private insurance companies to provide some of the coverage, but details vary based on the program and eligibility of the patient. Some Advantage Plans team up with health maintenance organizations (HMOs) or preferred provider organizations (PPOs) to provide preventive health care or specialist services. Others focus on patients with special needs such as diabetes” (Medical News Today, 2013).
The last part of Medicare includes a prescription drug plan, known as Part D. Part D adds prescription drug coverage to original Medicare, some Medicare Cost Plans and Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. Insurance companies offer these plans and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans (Medicare, 2013).
III. About Medicaid
Medicaid is a health care and long-term care coverage program that is jointly financed by states and the federal
Part A The central point of this scenario is far more than just healthcare management. Instead, it has elements of medical ethics and the huge amount of bureaucracy often engendered by the American healthcare system. Medicare Part A is hospital insurance that helps cover care in hospitals and skilled nursing facilities. In general, it covers inpatient care and inpatient rehabilitation costs. Medicare Part B covers medically necessary services: doctors', medical equipment, home
Medicare Part C is “Medicare Plus (+) Choice plans offer a number of health care options in addition to those available under Medicare Part A and Part B.” Fordney, M. T. (2017). The plans on Medicare Part C include, “health maintenance organizations (HMOs), fee-for-service plans, provider-sponsored organizations, religious fraternal benefit societies (RFBS), and Medicare medical savings accounts.” Fordney, M. T.
Medicare Part D was created under the Medicare Prescription Drug, Improvement and Modernization Act of 2003. (Medicare Part D, 2011). It is also known as the prescription Drug Plan. This plan was created to help cover cost of prescription drugs, and people who have the original Medicare or Medicare Advantage are eligible to enroll (Medicare Part D, 2011). Prescription drug coverage is only offered through HMOs, PPOs, and PFFSs and by some private companies who contract with Medicare through individual plans (Medicare Part D, 2011). Private companies are allowed to create their own customized benefit plan as long as the plan is as good as the plan outlined in the 2003 Medicare Act (Medicare Part D, 2011).
Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the
Medicare and Medicaid are very different, Medicare is a insurance federal program while Medicaid is an assistant program for low income people of any age. Medicare then serve people over 65 years primarily, under Medicare patients pay the costs through deductibles for hospitals and other cost. Medicare consist in two part; Part A which is the hospital insurance and Part B which is the Medicare insurance, they also have Part A Premium and Part B Premium. The Medicare Part A Premium you pay certain amount of money a month, but if you are 65 and meet certain criteria that they have ,you can get the Premium-free Part A. Medicare Part B after you meet your deductible, you normally pay 20% of the Medicare approve amount for doctors services, including
Medicare Part D is prescription drug coverage. It’s the newest part in Medicare. It adds prescription drug coverage to original Medicare, some Medicare cost plans, some Medicare PPS plans, and Medicare Medical Savings plans. Beneficiaries choose the drug plan and pay a monthly premium.
Medicaid and Medicare was created and called the Social Security Act of 1965 to provide coverage for medical treatment for qualified individuals and their families. Medicaid is a program that is jointly funded and managed by the federal and state governments that reimburse hospital and physician for providing care to qualified patients who cannot afford medical expense. To qualify for Medicaid he or she must be a United States or resident citizen which, includes low income adults and their children, people with certain disabilities and senior citizens. “Medicaid and Medicare is overlooked by the Center for Medicare and Medicaid,
The Medicaid program is a federal health insurance program for the under-privileged and incapacitated. The plan is managed by states within comprehensive limits instituted by the federal government. Together the federal and state governments finance the program, with the federal share ranging from 50 percent to 74 percent. Now Medicaid currently makes up 7 percent of the federal budget and 23.7 percent of all state expenses. Approximately sixty million people are enrolled in the Medicaid program and 400 million is spent annually.
Medicare is the federal health insurance program for people with certain disabilities, end stage renal disease, and for those who are over the age of 65. There are four different parts to Medicare, part A, part B, part C, and part D. Medicare Part A, also known as hospital insurance, covers inpatient hospital stays, care in nursing facilities, hospice care, and some in home health care. Part B is often referred to as medical insurance; it covers certain doctors’ services, outpatient care, medical supplies, and preventative care services. Medicare Part C, otherwise known as Medicare advantage plan is offered by a private
Medicaid provides healthcare insurance for individuals and families with low income. The federal government controls the program, but the states establish their own eligibility requirements and determines the type, duration, rate of payment, and amount of services. Even though the state can make final decisions on what they
One of the problems of Medicare itself is that it doesn't cover the costs of prescription drugs for its members; this has led to one of the major reasons that the program is in danger. A great deal of personal healthcare relies on the use of drugs, and since the program doesn't cover these costs, the individual must bear them. According to the AARP, in 1999 out-of-pocket costs for prescription drugs were estimated to be $450 per person each year (AARP). Obviously, members have joined the program to defray their medical costs, but these figures indicate that they still have large costs to pay. The other problem faced by the Medicare program is that it is also suffering from a lack of funds. According to Governor George W. Bush, the financial health of Medicare is in serious jeopardy and might face deficit as soon as 2010 (Bush). As a result of these major problems, one might wonder why the plan isn't scrapped for another program; well according to polls done by the Public Agenda, an Internet public policy site, American citizens are strongly in favor of Medicare, and would rather see the problems ironed out (Public Agenda). Therefore it is necessary to come up with a solution, so that the Medicare program remains intact.
Clearly, the Medicaid program is ripe for a major overhaul, a task that the federal government has thus far been unwilling to undertake. I chose this topic because I believe that the Medicaid program can be rescued and revitalized by leadership; otherwise, it is likely to be eroded. Medicaid is a government-sponsored program whose objective is to provide patients with health assistance upon meeting specific criteria. Medicaid is an insurance program that is available for disadvantaged persons, including the elderly, who cannot afford health benefits because of low incomes or other factors. This program is subsidized by government funds and in many instances, will cover the costs of basic
At its initiation in 1965, Medicare expected to provide health insurance to Americans age 65 and older and to younger people with certain disabilities or health conditions. It was a two-part plan. Part A providing payment to the hospital, home health following hospital stays, skilled nursing facility, and hospice care for the aged and disabled. Part A is paid by payroll deductions with no premiums for those who contributed. Part B, is an optional medical insurance program for which enrollees pay a monthly premium. Part B can be used to pay for physician, outpatient hospital, home health, and other services for the aged and disabled. Although it was considered during the 1930’s as a part of president Roosevelt new deal. It was believed that the inclusion of the plan could jeopardize the success of social security and hence was not added at that time. President Truman officially initiated the talks on national health insurance program, but LBJ finally signed it into law and added it to the Social security amendment in 1965. Since 1965 Medicare had changed multiple times with extended eligibility to individuals under age 65 who have long-term disabilities or end-stage renal disease. Addition of Part C (Medicare+Choice), also known as Medicare Advantage, drug benefit inclusion or Medicare Part D, the most recent Patient Protection and Affordable Care Act. The responsibility for overseeing Medicare and it funding lies with the Department of Health and Human Services (HHS).
In this essay my intentions are not to describe in full the features of the Medicaid as an insurance program or to make standing revision of its budgetary or galenic form. Instead, I will compel a short recount on its original characteristics when it first started and the positive or negative performance the program provides its recipients in the United States population. Furthermore, I will move bases on how Medicaid is affecting our budgetary systems and its upcoming sustainability. Nevertheless, this paper will contour how the Medicaid program has grown as a major framework of the United States and the unique
In the beginning, the basic design of the Medicare program was modeled on the private insurance system in place in the 1960s. The program has a variety of plans and services for its beneficiaries. Part A was a type of hospital health insurance which provided hospital, skilled nursing facility and home health agency coverage. This coverage was provided free of premiums to most eligible members, but those who were ineligible had to pay a monthly premium. In addition, Medicare included Part B also known as supplemental medical insurance. Part B helped pay for physician, outpatient hospital, home health agency and other services. To have this coverage, all eligible members must pay a monthly premium. This program has helped improve the health and longevity of older Americans. Today these programs are commonly referred to as the “Original Medicare,” in comparison to the current state of Medicare due to the changes Congress has made over the last fifty one years.