Financing by Individuals or Society?
Medicare insurance must be changed if it is to be sustained
Its benefits package still closely resembles the standard package available in the mid 1960s:
70% of medicare enrollees have traditional indemnity insurance at a time when less than 2% of the insured have conventional insurance
Medicare payments are not intended to cover all the medical needs of enrollees, nor should society pay for all these expenses
Only 1 in 10 individuals over 65 relies solely on Medicare insurance; the rest have:
Medicaid insurance
Employer provided coverage
Supplementary health insurance in addition to Medicare
Indeminty Insurance Plans: different than policies offered bby HMOs, PPOs because it allowes you to obtain medical care wehre you choose providing compensation for a set portion of the cots. IT does not force you to choose a primary care doctor and you can self refer to specialisist. Very simliar to Fee-for service
Complexity of Medicare Insurance Part A: Hospital, Skilled Nursing, Home Health, and Hospice Care
Medicare Part A covers hospital insurance
Pays for almost ΒΌ of benefits spending:
Most of the Medicare insured do not pay premiums for this benefit, because they have already paid it through their payroll taxes
Part A does not cover custodial or long term nursing care, and consumers must meet certain eligibility criteria for home health and hospice care
The home health care benefit is available to individuals certified by their physicians as homebound
The Medicare hospice benefit is available only to individuals whose physicians have certified their expected mortality is less than six months away
Complexity of Medicare Insurance Part B: Physician, Outpatient, Home Health Care, and Preventive Services
Medicare Part B covers physician visits, outpatient visits, preventive services, and some home health visits
Most people pay a monthly premium for this insurance:
Medicaid insurance may subsidize premiums based on income eligibility, which varies by state
Services are provided on a medically necessary basis
No coinsurance or deductible is charged for an annual wellness visit or for preventive services
Complexity of Medicare Insurance Part C