Student offers an overview of Medicare

In this paper, aspects of Medicare part A and B will be discussed. Information on the legislation that established the program, when the program began, the purpose of the program, eligibility and benefits, program funding, and program issues will be the core of this paper. To understand this program, let us consider the legislation that established the program, historical context, and the year the program began will be discussed.

 In 1965, President Johnson signed Medicare into law after many previous presidents had proposed national health insurance into the political agenda. In fact, FDR, Truman, Eisenhower, and even Kennedy all had hoped to see some sort of national health care law passed, but all had only minor victories in this area. Opposition was just too strong. European nations passed major health care system laws in the 1910s through the 1940s, and America was somewhat left behind. This was a major priority of the Johnson administration because of the increase in health costs and the decrease in income that both come with old age. Before Medicare was established, the majority of people age 65 and older did not have health insurance because of the high costs associated with such insurance.  Also, in the 19th and early 20th century, medicine was not so advanced, nor was it so expensive, so rather than pay small fortunes to preserve their health and wellness into old age, Americans tended to either get inexpensive medical help or die. This was changing in the 1960s, and it was clear that older Americans would not be able to afford care unless they had the help of insurance, but the sort of insurance that could be profitably provided to senior citizens would be too expensive for most older Americans. 

Medicare was Johnston’s solution to this problem. Medicare was an established through an amendment to the Social Security Act of 1935 and originally covered Americans age 65 or older, but was later extended to include people under the age of 65 with certain disabilities. Medicare part A and Part B were the two original parts of Medicare.

In general, the purpose of Medicare is to provide federally funded health insurance to people age 65 years and older and to others with qualifying disabilities. Medicare has many parts that cover various areas, but parts A and B are the most significant portions of this health care system. According to Medicare Interactive, “Part A (Hospital Insurance) covers most medically necessary hospital, skilled nursing facility, home health, and hospice care” and “Part B (Medical Insurance) covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services” (2017). There are certain eligibility requirements for each section. According to the Kaiser Family Foundation, 

Most people ages 65 and over are entitled to Medicare Part A if they or their spouse are eligible for Social Security payments and have paid payroll taxes for 10 or more years. People under age 65 who receive Social Security Disability Insurance (SSDI) payments generally become eligible for Medicare after a two-year waiting period, while those diagnosed with end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS) become eligible for Medicare with no waiting period (2016). 

As mentioned above, Medicare Part A benefits cover Hospital Insurance and Medicare part B benefits cover Medical Insurance. Another benefit of Medicare is that income, medical history, and current health status are not taken into account in determining eligibility for Medicare.

Medicare is the second largest government program and contributes about $692 billion dollars to the federal expenditure yearly. The Congressional Budget Office’s projections are for Medicare costs to be at about $707 billion (gross expenditure, not net expenditures) in 2018, and go up to over a trillion dollars in 2023, reaching $1.5 trillion in 2028 (see table 2-2 of the CBO’s 10-year budget projections). Medicare accounts for 15% of federal spending. Medicare is funded by many different sources depending on the type of coverage being used. The sources include general revenue, payroll taxes, beneficiary premiums, states, payments, taxation of social security benefits, and interest (Kaiser Family Foundation, 2016). Regarding funding for Medicare part A, the Kaiser Family Foundation states, 

Part A is funded mainly by a 2.9 percent payroll tax on earnings paid by employers and employees (1.45% each) deposited into the Hospital Insurance Trust Fund. Higher-income taxpayers (income greater than $200,000/individual and $250,000/married couple) pay a higher Medicare payroll tax on earnings (2.35%)” (2016). Funding for Medicare part B comes from, “general revenues and beneficiary premiums ($121.80 per month for beneficiaries paying the standard premium in 2016, and $104.90 for beneficiaries protected by the hold-harmless provision). Medicaid pays Part B premiums on behalf of beneficiaries who qualify for Medicaid based on having low incomes and assets. Beneficiaries with incomes greater than $85,000 for individuals or $170,000 for married couples pay a higher, income-related monthly Part B premium, ranging from $170.50 to $389.80 per month in 2016
(Kaiser Family Foundation, 2016). 

Like most programs, Medicare does not come without its issues.  For example, Medicare does have benefit gaps for services such as dental, eyeglass, and hearing aid coverage which are common needs of people age 65 and older. Also, people covered by traditional Medicare (Parts A and B), are subject to high deductibles, cost-sharing requirements, and no limits on the beneficiaries out-of-pocket spending (Kaiser Family Foundation, 2016). In other words, it is necessary for many beneficiaries to have supplemental coverage to help cover the possible costs that may come from coverage gaps or out-of-pocket costs.  

In conclusion, Medicare is a federally funded health insurance program that started in 1965 and has the general eligibility requirements of being age 65 or older or having a qualifying disability. The type of coverage a beneficiary receives depends of which part they are enrolled in, Medicare part A being Hospital Insurance and Medicare part B being Medical Insurance. Funding also depends on which benefits are being received. Existing issues such as coverage gaps and out of pocket costs can be offset by enrolling in a supplemental insurance plan. 

References

Medicare Interactive. (2017). What does Medicare cover (Parts A, B, C, and D)? Retrieved September 25, 2017, from https://www.medicareinteractive.org/get-answers/introduction-to-medicare/explaining-medicare/what-does-medicare-cover-parts-a-b-c-and-d

Kaiser Family Foundation. (2016, April 01). An Overview of Medicare. Retrieved September 26, 2017, from http://www.kff.org/medicare/issue-brief/an-overview-of-medicare/?gclid=CjwKCAjw0qLOBRBUEiwAMG5xMFw-Y8jF229OQjFt8R1j6vPqWc7PbTvWvgrnIEWK3wVE1HTOR4RHXxoCFrwQAvD_BwE

Student writes complaining of Medicare's caps on physical therapy services

To Whom It May Concern, 

I have resided in Illinois for my life.  I live in Greenfield, Illinois, which, if you are not sure, it’s a small town and everyone is here to help one another.  I used to work at Blue Cross Blue Shield as a Customer Representative and due an unforeseen stroke, I had to quit work.  As a community as well as a former BCBS representative, we are there to help other people.  We see other people who been through the best and worst of things try to get better and move on with their lives.  We also take care of the elderly and people with sickness, cancer etc., and we try to help out by taking care of each other.  We are a tight knit community.

I am also not a big fan of politics.  I want the people to get into their positions by what they stand for, be listening and “go with my gut feeling” so we can see some movement in our policies.

In that regard, I want to speak to you about Medicare and Physical Therapy for people with Parkinson’s and Multiple Sclerosis. People that have these diseases do benefit from repeated physical and speech therapy.  Their quality of life depends on these benefits to gain a sense of normality.  I have been working with a woman, ____, who has Parkinson’s disease for about a year now, and her condition has taken a down-ward spiral over the last couple of years.  She used to work at the ______ _______, and although she had this disease, she could still work.  About ten years ago, she was taken off working because her tremors were getting so bad.  She used to walk, but now she is confined to a wheelchair.  She now has a nerve receptor to handle the tremors and she has been signed up to receive physical and speech therapy to gain some access to walking and swallowing techniques.

According to Medicare, “There is currently a combined $1,920 yearly cap for physical therapy and speech-language therapy, and a separate $1,920 yearly cap for occupational therapy.”  I know there can be an extension for additional services, however, after the $1,920 year-cap, it’s not getting approved through Medicare, and the facilities do not want to extend their services in fear on not getting paid.  That would become the patient’s responsibility.  Patients cannot afford to go under for physical and speech therapy.  How would they recover?

I have seen ____ progress immensely with the therapy she has received but once that happens she has to start all over again to regain her strength back.  It’s very sad to see her start over and over again to only gain her where she was before she stopped going to therapy.  She could actually get up and walk!  Her body responded well to the therapy.  She actually could feel her gaining strength! That also affected using the bathroom and showers.  She didn’t get so close to falling but, after a month or two she lost all her strength and she ended right back where she was before.  It breaks my heart.

If we can use Medicare and have guidelines to approve extended visits, such a policy would be great.  If they could send in records to show what improvements they have made with the physical therapy and speech therapy, to acknowledge what they did, then Medicare could cover it. I understand that some people will not make any improvements, and I understand that when there is no clear sign of effectiveness it makes sense to have a cap and say that after spending a certain amount and showing no benefit, that can be the end for the year.  However, when people show improvement, the cap is too low; the people who should continue therapy will only gain strength with momentum and possibly have a pain free life if they get continuous therapy, so the cap on therapeutic services is very harmful and destructive.  I know this is newer to Medicare with Parkinson’s and MS, so if we could take a look at this, we could improve Medicare for people who are relying on services.  And let’s face it, $1,920 would not get very far with therapy, but that would really help those who need it and want to stay in their home without the use of nursing home and skilled care.  To me, that would increase the payments going out, but would be a lot less for a nursing home care.

I appreciate your time and attention to this matter.

Warm regards,

[Student Name]