The government has tried to control healthcare

QUESTION

Medicare ReformThe government has tried to control healthcare spending mainly through Medicarereform. In 1997, Congress expanded Medicares managed care program and renamed itMedicare+Choice. By encouraging seniors to join a private plan, they would save moneyand have a more complete package of health coverage. President Clintons plan boughtMedicare some time. According to the below chart, in 1997, Medicare began to makesome remarkable strides. You see a positive trend until the baby boomers begin to retirearound 2013.(Bettelheim, 2003, p.14)The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 isthe latest attempt to salvage Medicare from becoming extinct in 2026. Preventive benefitsare to begin in 2005. For those enrolled in Medicare Part B, there will be a one-timeinitial physical exam. The physical exam includes screening for diabetes, various cancers,and cardiovascular diseases, as well as immunizations against the flu and pneumonia.Bettelheim (2003) stated,Beginning in 2006, seniors will pay a monthly premium of $35, and anannual deducible of $250. In exchange, the government would pay 75% ofdrug cost from $250 to $2250, but seniors would pay drug costs from$2251 to $3600. Only after the senior paid $3600 will Medicare pay 95%of further drug costs (p. 6)To help control government costs, drug discount cards will be available until theMedicare prescription drug benefits begin in 2006. œSeniors will save 10-25% off the costof medicines (p 26). Private health plans will compete for seniors business by providingbetter coverage at affordable prices. This helps control the costs of Medicare by usingmarket-place competition. Seniors can choose to stay in traditional Medicare, or thosewho like the lower cost sharing and extra benefits often available in MCOs would be ableto make that choice as well.Medicare reform. The reform of Medicare and the addition of supplementalpolicies have lengthened the lifespan of the assistance programs, but at the expense ofpatients and society. Most seniors are on fixed incomes and the cost of supplementalprograms impedes their ability to continue their quality of life. Additionally, babyboomers entering this realm will overburden the system, creating larger deficits, anddestroying any remaining quality of care that is being provided.Medicare SummaryMedicare is basically broken down into two main categories: the "OriginalMedicare Plan" and the "Medicare Advantage Plan." Each category is made up of foursub-categories: Part A, Part B, Part C and Part D.Part APart A is hospital insurance provided by Medicare. Most people do not pay apremium 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 byPart A.Part BPart B is medical insurance to pay for medically necessary services and suppliesprovided 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, andadditional home health care.Part C (Medicare Advantage Plan)Part C is the combination of Part A and Part B. The main difference in Part C isthat it is provided through private insurance companies approved by Medicare. With thisprogram, you may have lower costs and receive extra benefits.Part DPart D is stand-alone prescription drug coverage insurance. Most people do haveto pay a premium for this coverage. Plans vary and cover different drugs, but allmedically necessary drugs are covered. You can choose what drug plan will be best suitedto your needs.ReferencesBettelheim, A. (2003). Will policy makers agree on prescription-drug benefits? MedicareReform, 13(28), 1-31.Medicare Parts A-D. (2008). Retrieved from http://www.medicareconsumerguide.com/.

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