Medicare is a social insurance program initiated by the United States(US) government to cater for medical expenses of her citizens above the age of 65 and those under 65 but with permanent physical disabilities, congenital physical disability, permanent kidney failure and amyotrophic lateral sclerosis. The model only covers for a portion of the total cost of the medical expenses excluding long-term care. The program was established in 1965 as an amendment to the social security legislation. The program is financed by tax payer cuts as outlined by the Federal Insurance Contributions Act (FICA) of 1954.
The insurance program applies only to legal residents of the US for a span of at least five years. To remain eligible for Medicare, those aged 65 and above must pay a monthly premium if they or their spouse did not pay the Medicare taxes for at least ten years while working. The program is divided into four parts denoted, A, B, C and D. part A involves hospital insurance. This covers all inpatient expenses including food and tests. The part covers short term hospital stays of about three days; however it also covers a longer stay in a skilled nursing facility of up to one hundred days. This entails full payment by Medicare for the first 20 days and a co-payment over the remaining 80 days. Most insurance firms in the US recognize the skilled nursing care in their policies.
Part B involves medical insurance and mainly focuses on outpatient services. The provision of part B is optional and one can defer it if a beneficiary or spouse is still working. It includes physician and other general nursing services, laboratory services, diagnostic and x- ray tests. The model also covers for ambulance services, blood transfusion, chemotherapy and other outpatient procedures. This part of Medicare program also covers some forms of medical tools such as walking canes, wheelchairs, and scooters to cater for those with locomotive challenges. Other equipment provided for under this program includes artificial limbs, eyeglasses following cataract surgery and breast prosthesis following mastectomy. The Centers for Medicare and Medicaid Services (CMS) board sets the rules to govern and regulate the coverage under the benefit in accordance with federal regulations and the Social Security Act.
Part C allows for beneficiaries of the Medicare plan to receive their benefits through private insurance arrangements as opposed to the earlier requirement of using the state controlled Medicare plan. The part C, christened “Medicare Advantage” cover includes drug prescription. This plan is effected by private companies under the guidance of CMS to avoid cases of fraud in the health care sector. Through this provision, the Medicare beneficiaries can access the services from any part of the country. The Medicare Advantage plan allows for the people under it to pay monthly premiums on top of the part B amount to cater for the prescription drugs, health club membership and dental and vision care. Part D of the program was added in 2006 following an Act of parliament, Medicare Prescription Drug, Improvement and Modernization Act. According to this provision, any Medicare beneficiary is mandated to enroll in a prescription drug plan (PDP). This coverage is not standardized and can be administered even by privately owned health insurance firms. These firms cover different classes of drugs according to the financial ability of the clients. Beneficiaries of both Medicare and Medicaid programs, benefit only partially from both programs. For instance, Medicaid only pays for drugs not covered by part D of the Medicare. The Medicare has been negatively affected by inflation and other financial challenges. The Medicare Board of Trustees has warned that the program could record bankruptcy by 2017.
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