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Discussion 1: Koffi
Medicare is the health care system that allows the federal government to provide health care coverage to old people at 65 and older or to severe disability people with no consideration of their income. Medicare is the healthcare industry’s largest payer (Niles, 2015). The Medicare in order to fulfill its mission, has subdivided the system in to four different parts and this gives many options to individuals or groups to decide what healthcare covering they want.
The Medicare part A which consist of hospital insurance is the contribution of the employer and the employee in form of social security fund (form of taxes). It has its benefits and covers hospital care, skilled nursing facility care, nursing home care and many others (CMS, 2016a). The Medicare part B is original Medicare called Voluntary Medical Insurance and is the additional plan to pay for physician services. This plan is funded by the federal treasury after the enrollee pays 24% as deduction of the healthcare. This type of insurance covers medical necessary service and preventive service. The enrollment of the part A Medicare allows access to part B (CMS, 2016a). Medicare part C is called Medicare advantage and seems to be the best Medicare because it also covers part A and part B benefits. Here you will have a fix amount paid by Medicare to the company providing you care every mouth (SMS, 2016b). Lastly, we have the Medicare part D which is prescription drug benefit and is the funding of tax revenue paid to the federal government. It has many benefits in addiction to the drugs prescription benefit (CMS, 2016c).
References:
Niles, N. J. (2015). Basics of the U.S. health care system. Burlington, MA: Jones & Bartlett Learning.
Sharp, N. (1995). Medicare. Nursing Management (Springhouse), 26(11). doi:10.1097/00006247-
What’s Medicare? (n.d.). Retrieved April 04, 2018, from https://www.medicare.gov/
Discussion 2: Susan
Medicare was signed into law under Title XVIII of the Social Security Act on 30 July 1965 by President Lyndon B. Johnson. Medicare is a single-payer (Federal Government) healthcare insurance program for individuals 65 years or older and individuals under 65 with disabilities that receive social security disability. Medicare is funded through a payroll tax, premiums deducted from beneficiaries’ social security payments and federally collected general revenue. It consists of four parts: Part A and B, which were the original components of Medicare and Parts C, and D which were added later.
Part A covers inpatient hospital stays, services, and tests up to (typically) 90 days and stays in skilled nursing facilities for rehabilitation or convalescence up to 100 days. It also covers home health care, and hospice if the beneficiary qualifies for this type of care. It does not include long-term care facilities. Part A is essential to recipients of inpatient hospital care, as it can be the most expensive healthcare cost involved with aging. A lengthy stay could wipe out an individual’s retirement savings if Part A was not available to cover such cost. Most beneficiaries do not pay a premium for Part A, as they or their spouse paid into the Medicare fund while employed, with an employer matching component.
Part B covers outpatient services to include physician office visits, diagnostic testing, laboratory tests, and immunizations for flu and pneumonia. It also covers annual wellness exams and outpatient hospital procedures, renal dialysis, mental health treatment, durable medical equipment and other medical services warranted and performed in a physician’s office or medical facility on an outpatient basis. It also covers some services that Part A does not include. Part B does not cover 100% of all cost. It pays 80% of the set rate for approved services. The recipient pays the remaining 20% out of pocket or through their Medicare supplemental insurance plan. Part B provides the bulk of preventative care coverage which is vital to ensure that seniors seek outpatient care when necessary rather than forgoing care due to cost and having illnesses develop into more severe conditions.
Enacted in the Balanced Budget Act of 1997, Medicare Part C coverage is a managed care program intended to entice Medicare patients into less costly health insurance programs. Rather than a fee for service type care, the health maintenance organization (HMO) or preferred provider organizations (PPO) would be paid a capitated rate per member. While managed care provides beneficiaries quality care, there may be a loss of provider choice and the need for a referral before seeing a specialist. Beneficiaries pay a premium for electing Part C coverage.
Due to the rising cost of prescriptions and the number of Medicare beneficiaries that are taking multiple daily medications for chronic conditions such as hypertension, diabetes, and elevated cholesterol, Congress passed the Medicare Prescription Drug Improvement and Modernization Act of 2003, which was effective 1 January 2006. This entitlement subsidizes the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. Part D coverage is most important given the high cost of prescription drugs and the average number of prescription drugs that people over 65 are taking daily. According to the Centers for Disease Control and Prevention (CDC) in 2014, 74% of people over 65 had taken at least one prescription drug in the past 30 days, and 40% had taken five or more (FastStats, Health Care and Insurance, Therapeutic Prescription Drug Use, 2017). Part D coverage is essential for this age group to ensure that their medications for chronic conditions are available. Many cash-strapped seniors would forgo their medications without this program. However, supplemental insurance coverage is needed to cover copays as well as the “donut hole” gap.
In summary, Medicare is a vital entitlement to individuals over 65 and those disabled. As the U.S. baby boomer population ages and life expectancy lengthens, this program will become more utilized and will need additional funding sources to cover its increasing costs.
References
FastStats, Health Care and Insurance, Therapeutic Prescription Drug Use. (2017, May 3). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.
Medicare Program – General Information. (2014, July 25). Retrieved from Centers for Medicare and Medicaid Services (CMS): https://www.cms.gov/
Niles, N. (2018). Basics of the U.S. Health Care System (3rd ed.). Burlington, MA: Jones & Bartlett learning.
Discussion 3: Debra
Public Welfare Insurance
Public welfare insurance is provided to families and individuals based on financial need (Niles, 2018). Medicaid and CHIP programs are two examples, and both are administered by state government. Medicaid is provided to the poverty-stricken, for example families who already receive benefits from the Temporary Assistance for Needy Families (TANF) program, those who receive social security income, pregnant women (below poverty level). For children whose parents cannot afford private insurance, The Children’s Health Insurance Program (CHIP) is available (Niles, 2018). Public welfare insurance is funded by federal and state governments.
When I became a single mother in 2007, the CHIP program was a lifesaver. My son was ineligible for Medicaid – my income was too high; however, my employer did not offer health insurance, and I could not afford private insurance. He was eligible for Florida Healthy Kids (a CHIP program), and my monthly payment was a very affordable $20 per month. His doctor visits cost $5; therefore, my share of cost was minimal. Additionally, $25 worth of over the counter medications was provided to him by mail order each month.
Pros – I believe that public welfare insurance programs are a necessary part of society. Most of the time people use the benefits only temporarily until they can get back on their feet or are provided with other options. Most people will not get medical help if they don’t have insurance; public welfare insurance opens the door to health care for the poor, elderly, and children. With Medicaid there are generally no co-pays or deductibles. According to the article Medicaid: Pros and Cons (2018) physicians who accept Medicaid are guaranteed to have a good amount of patients, and no need for advertisement since recipients are given a list of providers. Additionally, the risk of non-payment is extremely low, and some states even offer monetary incentives to providers who participate (Medicaid: Pros and Cons, 2018).
Cons – Medicaid does not cover everything, for example, experimental drugs/therapies, and treatments that are considered unnecessary. Many physicians don’t want to accept Medicaid because reimbursements are low dollar amounts, and the time it takes to get reimbursement can be very long – generally 37 to 155 days. Additionally, some discrimination against Medicaid patients has been documented in the nursing home setting where the patient may be placed in a ward rather than a private or semi-private room. Finally some states have complained that federal government’s distribution of funds is not appropriate – richer states get more $ while states with more needs get less (Medicaid: Pros and Cons, 2018).
References
Medicaid: pros and cons. (2018). Retrieved from http://www.
Niles, N. J. (2018). U.S. health care system (3rd ed.). Burlington, MA: Jones & Bartlett Learning
Discussion 4: Gina
The name of the company I chose is Facebook. I chose this because it is something I, and many people, use every day.
https://www.sec.gov/cgi-bin/
Net income $ 15,934,000
income tax $4,660,000
interest $391,000
15,934,000 + 4,660,000 + 391,000 / 391,000 = 53.67
I learned that Facebook can easily cover their interest expenses.
Discussion 5: Michelle
The name of the company I chose is Kraft Heinz Company. This is a merger between the Kraft and Heinz companies. The web address that led to my report is https://www.sec.gov/cgi-
ANSWER PREVIEW
Discussion 1: Koffi
Hello Koffi, I like your work. I like how you have introduced the discussion in the opening sentence that explains what Medicare is and who are covered under it. Also, you have tactically mentioned how important the program is so much so that it is the industry leader. You have also explained how the program is structured which serves to inform the reader of how the program actually works. Beautifully enough, you have also explored eligibility. However, you could have done better by perhaps including one or two statistics concerning the number of people currently benefitting from the program or how much the government actually spends on the program…………………………………WORDS 570