Medicare in United States
Medicare is a United States social insurance program for the physically unfit individuals such as the elderly and the physically incapacitated. It acquires its funds from the federal government and its main concern is the elderly. It is a health insurance program that covers Americans over sixty five years of age and those who are disabled (Colamery, 2003). It offers Medicare Part A which is a hospital insurance and caters for hospital bills paid through compulsory payroll tax; Medicare Part B referred to as Supplementary Medical insurance (SMI) for medical insurance. It’s voluntary and paid through Social Security premiums supplemented through federal funds. The plan has regulations to dictate eligibility of persons and the service to be offered. Fiscal agents operate Medicare billings under the federal government. Medicare Part C also called Medicare advantage comprises managed care plans, specialty plans, private fee-for-service plans and preferred provider organization plans. Medicare Part D handles Prescription drugs. It’s a voluntary plan with cost sharing regulations under different premiums. Medicare covers around ninety five percent of all American aged population and disabled persons. It is a great revenue source in many health facilities in the United States. In comparison, Medicaid does not entirely get its funding from the federal government but also from individual states. Medicaid is more of a social security program unlike Medicare which is a health insurance program. Its eligibility depends highly on personal earnings and monetary resources which is not the case in Medicare programs. It is possible to have dual eligibility for both Medicare and Medicaid services (Baker, 2011). It is very important since it not only provides health insurance for the eligible Americans but also finances residency training services for medical practitioners in the United States (Colamery, 2003).
Medicaid program was initiated in the United States in nineteen sixty five under the Social Security Act Amendments. The amendment created health insurance programs, Medicare to cater for the aged and Medicaid to cater for the poor. Medicaid is financed by the federal government paying attention to the states that are poor. It is a program under the federal government as well specific states which offers medical coverage for low earners and poor Americans. This is so since such citizens lack the necessary funds to handle their medical needs. Medicaid programs are present in every state guided by different regulations in assessing the needy ones. Those who become suitable for the services of Medicaid have to comply with specific requirements as stipulated by the state. Some of the citizens eligible for Medicaid are low income earners, those with particular disabilities and in some cases, poor families (Russell, 2008). It is very significant since it is the largest funder of health organizations and for Americans who are unable to afford health services. Most importantly, Medicaid funds nursing homes and a diversified number of health services as compared to Medicare program. Other than covering persons, Medicaid subsidizes health facilities to give care to a large number of uninsured individuals (Kongstvedt, 2009).
Managed cares was established in the United States through Health Maintenance Organization Act of 1973 aimed at regulating medical costs and at the same time ensure quality health care. The concept encompasses procedures that aims at decreasing the expenses of offering health services and developing the health care quality (Birenbaum, 1997). It is applied in the United States to decrease health care expenses which could be avoided through a number of ways. These include regulating inpatient admissions and period of treatment and economic incentives for medical practitioners and patient. Its significance includes enhanced efficiency and developed quality in health care. Through managed care plans, the program contracts with medical providers and facilities to offer quality care at less expenses. The healthcare providers comprise a network which has rules for funding. Managed care plans includes Health Maintenance organizations (HMO) which funds those in the network, Preferred Provider Organizations (PPO) which covers much for those in the network and less for those who are not, Point of Service (POS) which offers an option between PPO and HMO when needed (Kongstvedt, 2009).
The commercial funders comprise of employers who provide health insurance to their employees. The commercial sector is very competitive unlike noncommercial such as Medicaid and Medicare programs. Healthcare organizations and providers may opt to partner with retailers such as drugstores which fund much of their expenses as well as improving the relations with the community. Other than providing capital, the commercials may provide integrated care at patients’ convenience. Moreover, commercial insurers funds eligible healthcare for citizens who buy such policies from a healthcare insurance company. Commercial insurers are not concerned about how the health services are provided or the quality unlike Medicare, Medicaid and managed care. Other sources of funds in a healthcare organization are private pay from the patients especially in nursing homes. Health care facilities also receive funding from voluntary donors (Baker, 2011). In addition, they may acquire funds from commercial loans based on their financial records. The commercial lender needs to be aware of the repayment schemes. Its importance is that it necessitates health facilities to obtain capital that they is able to repay and enables access to funds which are kind of unrestricted unlike the Medicaid and Medicare funds.
Baker, J.J., R.W. Baker. (2011). Health Care Finance: Basic Tools for Nonfinancial Managers. 3 Ed. Sudbury: Jones and Bartlett Publishers, LLC.
Birenbaum, A. (1997). Managed Care: Made in America. Connecticut: Praeger publishers.
Colamery, S.N. (2003). Medicare: Current Issues and Background. New York: Nova Publishers, Inc.
Kongstvedt, P. R. (2009). Managed Care: What it is and how it works. Sudbury: Jones and Bartlett Publishers, LLC.
Russell, J.M. (2008). The Complete Guide to Medicaid and Nursing Costs: How to keep your Family assets Protected. Florida: Atlantic Publishing Group, Inc.