Eligibility requirements for Medicare, SCHIP, and PPACA

Medicare, SCHIP, and PPACA

Who is Eligible for Medicare?

Medicare is essentially an insurance program available to individuals when they reach retirement age. It is however important to note that to be eligible for Medicare, individuals must first satisfy a few requirements. To begin with, in addition to being a U.S. resident, one has to be of age 65 and above to be eligible for Medicare (Medicare, 2012). As Medicare (2012) further points out, the individual seeking to join the program (or their spouse) must have "worked for at least 10 years in Medicare-covered employment…" It is however important to note that those who have a disability do not necessarily have to be aged 65 years or older to be eligible for Medicare (Medicare, 2012). This also applies to individuals suffering from End-Stage Renal disease. Those who meet the age requirement above but do not have the prerequisite work history can opt to join Medicare via the payment of a monthly premium (Cordes, Ebel, and Gravelle, 2005). It should also be noted that according to Medicare (2012), those whose retirement benefits are accessed via either the Railroad Retirement Board or the Social Security and are aged 65 and above do not have to pay premiums for Part A. Those who do not meet this age requirement must have received Railroad Retirement Board or Social Security disability benefits for a period of not less than two years to access Part A (Medicare, 2012). In contrast to Medicare Part A, Medicare Part B according to Cordes, Ebel, and Gravelle (2005) "is voluntary for those eligible for Part A, but is heavily subsidized by tax payers."

What Government Agency Manages SCHIP? (Local; State; Federal)?

Although the federal government was responsible for the creation of SCHIP, the program is managed and/or operated by individual state governments. Indeed, the workings of each SCHIP is largely dependent on the state. It is however important to note that there are federal laws that each state has to adhere to in the management of the program. For instance, states are required by the law to provide an irreducible minimum set of benefits.

If You Were the HHS Secretary, What Recommendations Would You Make to the PPACA?

Although the relevance of PPACA cannot be overstated when it comes to the reduction of the overall cost of healthcare, several modifications could further enhance the relevance as well as efficiency of the Act. As HHS secretary, I would pursue a single agenda that would contribute to the further advancement of public health. This is more so the case given that experts have in the past criticized the Act for its failure to radically advance public health (Faust and Menzel, 2011). For instance, I could develop a framework that fully defines the utilization of curve-out programs in relation to behavioral health. Currently, the Act is largely silent on this issue.