Medicare Program

Medicare is a federal government program that pays for the health care costs of US citizens that are above the age of 65 years and the disabled. The federal government enters into a contractual agreement with private insurance companies that act as their agents to pay for health insurance premiums.

This program is divided into several divisions that contain standards which depict the type of insurance cover for health care centers. Part A of Medicare provides insurance cover to inpatients care in hospitals, nursing homes, skilled nursing facilities and critical access hospitals but does not offer health insurance cover to home based health care. Part A does not require payment of premiums or any deductible rates (AHIP 5-73).

The Part A plan for Medicare program in the Us only offers health insurance cover to certain medical services which involve blood transfusion that occurs while the patient is hospitalized in the hospital, hospital stays which should last for a maximum of three days that is from the midnight of admission to the midnight of the day before discharge date.

It covers for activities such as meals, general nursing care, provision of semi-private wards and other miscellaneous hospital activities and supplies. Part A also provides health care insurance cover to stays in nursing homes or skilled nursing facilities that are related to diagnostic activities for example rehabilitation (AHIP 5-73).

However, this cover is not applicable to custodians or daily living and only runs for a limited period of time that is 100 days where it offers full payment for the first 20 days and a co-payment plan for the next 80 days. Part A also provides hospice cover to critically ill patients that have only six months or less to live where it offers payment for general nursing services, drugs used and grief counseling processes among others.

It also provides additional hospital care to help medical practitioners on duty to rest. Furthermore, Part A offers health insurance coverage to home based health care only if it includes skilled nursing care carried out on a part time basis such as occupational therapy, speech language pathology and lessons on home use equipments like wheel chairs (AHIP 5-73).

Medicare Part B plan requires payment of premiums which are usually deducted from incomes and civil retirement checks, railroad retirement or social security checks. Therefore, this health care coverage is offered to only eligible clients.

Part B offers insurance coverage to many medical services that are not covered in Part A but it does not offer 100% insurance cover. Medical services that are covered include; general nursing care, testing services, home based health care, mental health care, transplant services and preventive services such as preventive shots like flu shots which are covered once in a year when there is an outbreak and Hepatitis B shots that are usually given three times in a year but beneficiaries are only covered if they are at a medium or high risk state among others (AHIP 5-73).

Medicare Part D offers health insurance coverage to prescribed drugs to private companies that offer Medicare program. This plan helps to lower costs that arise from buying drugs that have been prescribed, provide access to medical drugs that maybe useful and reduce other miscellaneous future costs. However, it requires early registration to avoid paying extra costs because of late applications.

The eligibility criteria of acquiring Medicare Part D prescribed drugs coverage includes two procedures which are adding this plan into the original health insurance coverage. However, the applicant is required to pay another premium for this plan on a yearly basis.

Also one can join an managed care organization (MCO) that offers this insurance coverage where monthly premiums will be contributed in accordance to the health insurance plan the MCO has applied for (AHIP 5-73).

Membership cards are offered once applications are accepted and the card holder pays a co-pay and co-insurance deductible rates every time the card is used.

Some Part D plans contain a coverage gap which requires beneficiaries to pay for the cost of their prescribed drugs until they are unable to purchase the drugs where they will be required to pay a co-insurance value for the remaining months of the year as the insurance company pays for the remaining sum of money. If the beneficiaries cannot afford the Part D plan cost they can enroll into other programs such as Medicaid (AHIP 5-73).

Medicare program has different premium rates for each plan for instance the premium rate for Part A is approximately $133 dollars per day and that for Plan B is about $135 dollars per day. Premium rates for Part D depend on the type of plan but approximately 2.9% of the tax money is deductible.

The financial state of Medicare program is not stable and can be depleted quickly because it has been affected by the global crisis and the increased hospital costs which are transferred to insurance companies because of incorporation of advanced technology into the medical field to further improve the quality of health care delivery systems.

These facts have lead to the projection of the trust fund provided by Hospital Insurance (HI) falling below the annual expenditure by the year 2012 which is two years earlier because the funds had been predicted to be depleted by 2014 (AHIP 5-73).

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Works Cited:

America’s Health Insurance Plans (AHIP). “Trends and Innovations in Chronic Disease   Prevention and Treatment”. Journal for America’s Health Insurance Plans 2.4 (2008):         5-73.