Medicare Project

Medicare Project

In 1965, U.S. President Lyndon B. Johnson passed the Medicare Benefit legislation as an amendment to the Social Security Legislation after 20 years of debating. Medicare is a health insurance program for U.S. citizens at least 65 years old, or those aged younger than 65 years who suffer from certain disabilities. In 1965, nearly half of the elderly had no health insurance and many others did not have enough coverage. That is when Medicare was enacted to help assure that almost all citizens at the age 65 or older would have health care coverage. The program was modeled on the standard employer sponsored health plans of the day.

As the Nation moves into the 21st century, Medicare is facing serious financial challenges. Over the next 50 years the number of beneficiaries are expected to more than double while the ratio of workers, whose payroll taxes fund over half of the program, to beneficiaries is expected to decline from about 4 to 1 to a little over than 2 to 1. In recent estimates from the Congressional Budget Office and the Administration predicted that the program will be bankrupt about the time the growth in beneficiaries accelerates as the baby boom generation started to become eligible in 2010.

People seem to get Medicaid and Medicare confused. Medicare and Medicaid are both government sponsored programs designed to help cover healthcare costs. Both programs were established by the U.S. government in 1965 and are taxpayer funded, they are actually very different programs with differing eligibility requirements and coverage. Medicare is designed to help with long-term care for the elderly and Medicaid covers healthcare costs for the poor, but there is much more to it than this. Medicare is a federally funded health care program that provides basic medical insurance to qualified residents. It provides coverage for over 40 million people nationwide. Medicare is also becoming the America's leading health care insurance program.(2010). Not all health care providers accept Medicare. To be eligible for Medicare you have to meet certain requirements. I will discuss that later in my report.

Medicare is administered by the Centers for Medicare and Medicaid Services (CMS). It is a part of the Department of Health and Human Services (HHS) and it is administered by the Federal Medicare Program. The Social Security Administration is responsible for determining Medicare eligibility and processing premium payments for the Medicare program.

The Centers for Medicare & Medicaid Services (CMS) is an operating division of the Health and Human Services Department. It was established in 1977 to combine under one administration the oversight of the Medicare Program and the federal portion of the Medicaid Program. The three divisions of the Centers for Medicare and Medicaid Services are The Center for Medicare Management, The Center for Beneficiary Choices and The Center for Medicaid and State Operation. (Fordney, 2010, p. 418) CMS employs approximately 4,100 employees, of which 2,700 are located at the headquarters in Baltimore, Maryland, and the remainder in Washington, D.C. and 10 regional offices nationwide.

Medicare is broken down into two main categories which consist of the Original Medicare Plan and the Medicare Advantage Plan. Each category is made up of four sub-categories: Part A, Part B, Part C and Part D. The Original Medicare Plan consists of Part A and you have the option of adding Part B and D. When signing up, you will automatically be enrolled in the Original Medicare Plan unless you specifically choose to join a Medicare Advantage Plan (Part C). The Medicare Advantage Plan or Plan C combines your Part A and B coverage, but is provided by private insurance companies. With this one, you have the option of adding Part D if coverage is not already included. (2002-2011).

Part A is a hospital insurance provided by Medicare. Most people do not pay a premium for this coverage. Part A covers inpatient care in skilled nursing facilities, critical access hospitals, and hospitals. Hospice and home health care are also covered by Part A. Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. Most people will have to pay a premium to receive this coverage. Part B covers outpatient care, doctor's services, physical or occupational therapists, and additional home health care. Part C is the combination of Part A and Part B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare. With this program, you may have lower costs and receive extra benefits. Part D is stand-alone prescription drug coverage insurance. Most people do have to pay a premium for this coverage. Plans vary and cover different drugs, but all medically necessary drugs are covered. You can choose what drug plan will be best suited to your needs. (2002-2011).

After reading both cases, I know there are different qualifications for their Medicare. Both men will qualify for Medicare eventually. To be eligible, an individual needs to meet certain guidelines concerning age, citizenship and length of employment. In some situations, an individual under the age of 65 years may also be eligible for coverage, and a person may still qualify even if other health coverage exists.

The Medicare eligibility requirements require three questions. They want to know are you eligible, what plan are you eligible for and are you eligible for the Medicare advantage plan. So by Brad being 62 years old with a kidney disease, so he is eligible. When it comes to finding out which plan you are eligible for, there will be four parts. The medial health insurance parts are part A, B, C and D. Part A, B, and D are all grouped similarly as a part of the Original Medicare Plan, Part C is known separately as Medicare Advantage Plan. (Fordney, 2010, p. 418)

The eligibly requirement for Medicare in case 1 is he must have worked 10 years at a job that has paid into the Medicare system. I was not giving enough information in case 1. The only thing I know about him is that he is 67 and applying for Medicare. You are required to be at least 65 years old unless you are permanently disabled or have permanent kidney failure necessitating dialysis or transplant. There are also eligibility requirements for Medicare Parts A, B and D. To be eligible under Medicare Part A you must be over 65 and be receiving Social Security or Railroad Retirement Board retirement benefits. You may also qualify if you are eligible to receive Social Security or Railroad Retirement but have not yet applied for them. Finally, you may also qualify if either you or your spouse worked in a Medicare covered position for the government. Medicare Part A also provides coverage for recipients under 65 in certain situations. If you are under 65

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