History And Development Of Medicare Chapter

Length: 5 pages Sources: 5 Subject: Healthcare Type: Chapter Paper: #44149601 Related Topics: Dialysis, Legislative Process, Payroll, Dental
Excerpt from Chapter :

Health Care Policy: Medicare

Medicare in the U.S. was formed in 1966 and is defined is one of the national social insurance program whose administration is vested in the federal government. The policy is dispensed through 30 private insurance organizations in the country. Medicare avails health insurance to Americans of ages 65 years and older that had worked and paid within the national system (Nadeau, Belanger & Petry, 2014). The policy avails health insurance benefits to different younger people with amyotrophic lateral sclerosis, disabilities, and end-stage renal disease.

Medicare availed health insurance to close to 47 million residents in 2010. 40 million of them were of 65 years and above while seven million were younger individuals with disabilities. The policy was the primary point of payment for close to 15.4 million inpatient cases in 2011 that was $182.7 billion (47.2%) of aggregate inpatient costs in the United States hospitals. Medicare was a policy defined to serve a larger population for the disabled and elderly individuals. The average Medicare coverage is close to 48.3% of all health care charges among individuals enrolled in Medicare (Barr, 2011). Enrollees should cover the remainder of the charges through supplemental insurance and with alternative out-of-pocket coverage forms. The out-of-pocket charges vary with respect to the health care needs of a Medicare enrollee. The focus also includes uncovered services of hearing, dental, long-term, and vision where supplemental insurance is required (Nadeau, Belanger & Petry, 2014).

In 1965, the Medicare provisions expanded into inclusion of benefits for physical, chiropractic therapy, speech. In 1972, Medicare brought on different payment options of health maintenance organizations that lasted to the 1980s. In the 1990s, Congress focused on expanding Medicare eligibility for pump include younger people with permanent disabilities through allowing receipt of Social Security Disability Insurance payments (Almgren, 2013). The category includes people with end-stage renal diseases. Towards the end of the 1990s, the HMOs association was formalized through the President Clinton health policy in 1997. The year 2003 saw Medicare program include coverage of all drugs as passed by President George W. Bush and established effect from 2006 (Nadeau, Belanger & Petry, 2014).

The sources of financing for Medicare take several distinct dimensions. Part A financing is funded through revenue from payroll tax of 2.9% levied on workers and employers where each pays close to 1.45%. The focus was shaped in 1993 where the law availed maximum compensation amounts for Medicare taxes as imposed yearly. The approach was similar to what Social Security taxes worked from the United States. In 1994, compensation limits were removed. Self-employed individuals were required to pay the whole 2.9% tax based on net earnings from self-employment engagements. This is because they were both the employer and employee. However, they could deduct half tax charges from incomes in the calculation of income taxes (Moniz & Gorin, 2013).

The start of 2013 allowed for Part A 2.9% tax to apply to initial $200,000 income among individuals or the $250,000 for married couples who filed jointly. The focus rose to an average of 3.8% where incomes exceeded the amounts involved in partially funding the subsidies. Parts D. And B. were partially funded through premiums that Medicare enrollees paid as well as general fund revenues. In 2006, surtax additions within Part B premiums included higher-income variables and partial financing on Part D. The 2010 legislation on surtax was increased to Part D premiums with higher income categories partially funding the system (Almgren, 2013).

There are different circumstances through which people qualify for coverage of Medicare. Further, the policy defines how Part A of Medicare premiums can be waived entirely (Moniz & Gorin, 2013). Individuals qualify for the policy at the age 65 years. Other participants include U.S. citizens with permanent legal residence across five a period of five concurrent years with their spouses and qualifying ex-spouses having paid all Medicare taxes in the past decade. Another category of qualifiers include individuals under the age of 65 and with disabilities (Nadeau, Belanger & Petry, 2014). The focus includes receiving Railroad Retirement Board disability or Social Security SSDI benefits. The individuals should receive the benefits for close to 24 months from the entitlement date. The point of reference is eligibility for the initial disability payment prior increasing eligibility of enrolling...


Further, individuals getting continuing dialysis to address end stage renal disease and those requiring kidney transplants are persons qualifying in the policy. Lastly, people with eligibility for Social Security Disability Insurance as well as those with amyotrophic lateral sclerosis (Lou Gehrig's disease) are good candidates for the program (Nadeau, Belanger & Petry, 2014).

Individuals aged 65 years and older choosing to participate in Part A program of Medicare should pay monthly premiums to sustain their enrollment in Medicare. The policy is applicable in case they or immediate spouses have not made full payments of Medicare payroll taxes (Barr, 2011). People with disabilities are receiving SSDI share eligibility for Medicare even as they receive SSDI payments. The implication is that such individuals lose Medicare eligibility based on disabilities and if there is a stoppage of receipt of SSDI benefits. 24-month exclusion from policy means that individuals, who are disabled, should wait up to 2 years prior the receipt of government medical insurance. The alternative is to have them enlisted within the disease limits. 24-month periods are determined from the date in which individuals determine the need to be eligible for distinct SSDI payments. The dimension also eliminates the necessity of making first payments after actual receipt (Moniz & Gorin, 2013). Most of the new SSDI recipients are receiving disability pays that cover periods in of around six months from disability and end of the first month of SSDI payment (Moniz & Gorin, 2013).

Medicare is divided into four parts. Part A is a descriptor of Hospital Insurance while Part B involves Medical Insurance. Part D involves coverage of prescription drugs similar to the description and provisions of Part B. However, the health plans Part C have diversified popularity in which branded Medicare Advantages are alternative ways for Medicare beneficiaries to gain their benefits from Part A, B, and D. Besides, Part C is considered to be a public supplement option that is compared with supplemental Medicare provisions from former employers or private Medigap insurance. The Medicare benefits are later subjected to aspects of medical necessity (Nadeau, Belanger & Petry, 2014). The implication is that Medicare offers mechanisms in which the state continues taking portions of the citizens' resources for purposes of guaranteeing financially and health security to the citizens in their old ages (Barr, 2011). In disability, it is important to help them address the enormous and unpredictable health care costs. The dynamism of Medicare allows for substantial differences within private insurers in terms of making decisions. Further, the focus diversifies and individuals to be included in the cover and the benefits to be availed. The system provides for goals in the management of risk pools as well as guaranteeing that not all costs exceed the established premiums (Moniz & Gorin, 2013).

The federal government has a legal obligation of providing Medicare benefits to the disabled and older Americans. However, it cannot lower the costs through restricting benefits or eligibility except through difficult legislative processes (Nadeau, Belanger & Petry, 2014). Even though lowering costs through cutting benefits remains difficult, the policy can achieve economies of scale based on the prices that are involved in health care as well as in administrative expenses. The outcome is that private insurers' costs grow by almost 60% as compared to Medicare from 1970. Costs growth for Medicare is similar to GDP growth as well as expectations of staying below private insurance levels in the subsequent decade. The fact that Medicare avails statutorily determined benefits, payment rates, and coverage policies have enrollees entitled to similar forms of coverage (Moniz & Gorin, 2013). Private insurance markets offer plans tailored to avail differential benefits to different customers that are an enabler of individuals in the reduction of coverage costs and assuming risks that are not necessarily aimed at health care. However, insurers have fewer disclosure stipulations as compared to Medicare (Nadeau, Belanger & Petry, 2014).

Further, the policy is criticized various grounds. The initiation of Medicare was a representation of the shift from personal responsibility to the view that the focus on health care is based on unearned entitlements provided at the expense of others. The extensive obstacle in financing health insurance for the elderly people was the high care costs among the aged together with general low incomes among the retired people (Holtz, 2008). The fact that retired older people engage most of the medical care initiatives as compared to the younger employed people, insurance premiums in relation to risks among older people needs to remain high. However, if high premium is to be paid during retirement, when people's incomes are lower, it becomes almost impossible for average people to manage.

In conclusion, the Medicare policy has operated in the U.S. For over…

Sources Used in Documents:


Almgren, G.R. (2013). Health Care Politics, Policy and Services: A Social Justice Analysis. New York: Springer Publishing Company.

Barr, D.A. (2011). Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America. New York: JHU Press.

Holtz, C. (2008). Global Health Care: Issues and Policies. New York: Jones & Bartlett Learning.

Moniz, C., & Gorin, S. (2013). Health Care Policy and Practice: A Biopsychosocial Perspective. New York: Routledge.

Cite this Document:

"History And Development Of Medicare" (2015, January 18) Retrieved January 17, 2022, from

"History And Development Of Medicare" 18 January 2015. Web.17 January. 2022. <

"History And Development Of Medicare", 18 January 2015, Accessed.17 January. 2022,

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