United States has a health program based on health insurance which is called Medicare. It started in 1966 under Social Security Administration. However now it functions under Centers for Medicare and Medicaid Services. Basically, it extends health insurance for 65 years old and those still older. Younger people with certain disability are eligible for it. Last year Medicare extended health insurance facility to over 59.9 million individuals. The name Medicare in the US was given to medical program meant for families of military personal in 1956. 

Medicare pays for different health care expenses. It is an entitlement program. The citizens earn the right to enrol in this scheme through working and paying the taxes for prescribed period. In case the time frame of paying taxes is diluted due to some reason the citizen is eligible to enrol but may have to shell out more money. The four varying Medicare program has part A and B. This is the original Medicare. Part B covers outpatient services. Medicare C it is also called Medicare Advantage is the private health Insurance. Medicare D covers prescription drugs. 

The pros and cons of the scheme

Among the pros are the following;-

  • Coverage is given to those who wouldn’t have coverage-Millions of aged come under its preview. Youngsters with certain disabilities are also covered under this scheme. 
  • Costs less per month-Those enrolled are qualified for free Part A. However, they need to shell out some personal money every month for Part B. Still the savings for the patient is huge. 
  • Advantage Plan gives added coverage – More and more of the population is enrolling in this plan as well. This plan is sold by private insurance companies. In the treatment the citizen gets advantage of Part A Part B and Part C the advantage scheme.  The private companies have contract with Centres for Medicare and Medicaid Services. The cost incurred is a minimum. 
  • Prescription innovation-Medical companies are investing a lot of money in developing drugs meant for the elderly. 
  • The standards of medical pharmacy and admission has become better-Government has set standards for hospital enrolment programs. Hospital hygiene, re-admission and its cause are being followed. Public accountability compels the hospitals to function better.  

Cons for Medicare

  • The administration foot the huge costs for the scheme – Government spent 15% of the budget on Medicare scheme.  With coming years, it is going to increase. This budget could be diverted to education, fight poverty etc you think the worth of the program to the nation. 
  • Poor health costs more. Several patients suffer from preventive conditions. It should be avoided through precautions.
  • Hospital admission costs heavily – The poor manage to get in through the scheme. It is a burden on the hospital. The overall healthcare is strained. 
  • The statistics -Those aged 85 spend three times more on health care compared to 65-74. More medical issues erupt as age advances. Medicare is not adaptive to elderly. A scheme should be prepared where general public shoulders and shares the cost. 
  • Fraudulent doctors – In 2017 US charged some 400 plus doctors with fraud tactics. They were charged with opioid related crime. They billed drugs to the medical scheme when no such purchase was made.  Money was charged for false rehabilitation treatments and tests of the patient. They wrote out prescription and collected cash. The government will have to invest more cash in inquires for crime.  
  • Taxpayers contribute a huge amount – 38% of the Medicare money came through taxes. Each pay-check contributes to the funds. 

The patient can go directly to a hospital or doctor in case of need. Authorization or permission of Medicare is not needed. Patient is responsible to pay monthly premium for part B. Some are liable to pay for part A as well. Coinsurance must be paid for every service you get. The doctors and hospital cannot charge beyond a point. 

Categories: Health Insurance


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