Medicare Insurance Program in the U.S.


Medicare is a social insurance program initiated by the United States government to cater for the medical expenses of her citizens above the age of 65. However, for those who are under the age of 65, they must be with permanent physical disabilities, congenital physical disability, permanent kidney failure, and amyotrophic lateral sclerosis for them to be included in the Medicare program. The model only covers a portion of the total cost of the medical expenses excluding long-term care. The program was established in 1965 as an amendment to the social security legislation. The program is financed by taxpayer cuts as outlined by the Federal Insurance Contributions Act (FICA) of 1954.

The insurance program applies only to legal residents of the US for a span of at least five years. In order to be allowed to use Medicare, those who are above the age of 65 are required to pay a premium every month in case neither they nor their spouse remitted the Medicare taxes for a period of not less than 10 years when they were employed. The program is divided into four parts denoted as A, B, C, and D. Part A involves hospital insurance. This covers all inpatient expenses including food and tests. This part covers short-term hospital stays of about three days; however, it also covers a longer stay in a skilled nursing facility of up to one hundred days. This entails full payment by Medicare for the first 20 days and a co-payment over the remaining 80 days. Most insurance firms in the US recognize skilled nursing care in their policies.

Part B involves medical insurance and mainly focuses on outpatient services. As for the case of part B, its provision is not mandatory and an individual can postpone it in the event that the one to benefit or his/her spouse is still employed. It includes physician and other general nursing services, laboratory services, diagnostic, and x-ray tests. The model also covers ambulance services, blood transfusion, chemotherapy and other outpatient procedures. This part of the Medicare program also covers some forms of medical tools such as walking canes, wheelchairs, and scooters to cater to those with locomotive challenges. In addition, this program enhances the provision of other equipment such as breast prostheses, artificial limbs and eyeglasses to individuals who might need them. The Centers for Medicare and Medicaid Services (CMS) board sets rules to govern and regulate the coverage under the benefit in accordance with the federal regulations and the Social Security Act.

Part C allows for beneficiaries of the Medicare plan to receive their benefits through private insurance arrangements as opposed to the earlier requirement of using the state-controlled Medicare plan. Part C, christened “Medicare Advantage” cover, includes drug prescription. This plan is implemented by private companies under the guidance of CMS to avoid cases of fraud in the health care sector. Through this provision, Medicare beneficiaries can access the services from any part of the country. The Medicare Advantage plan allows for the people under it to pay monthly premiums on top of the part B amount to cater for prescription drugs, health club membership, and dental and vision care. Part D of the program was added in 2006 following an Act of parliament; the Medicare Prescription Drug, Improvement and Modernization Act. According to this provision, any Medicare beneficiary is mandated to enroll in a prescription drug plan (PDP). This coverage is not standardized and can be administered even by privately owned health insurance firms. These firms cover different classes of drugs according to the financial ability of the clients. Beneficiaries of both Medicare and Medicaid programs benefit only partially from these programs. For instance, Medicaid only pays for drugs not covered by part D of Medicare. Medicare has been negatively affected by inflation and other financial challenges. The Medicare Board of Trustees has warned that the program could record bankruptcy by 2017.

Annotated Bibliography

The following is an annotated bibliography on the Medicare program in the United States.

Case Studies on Medicare Program

Lubitz, J and Prihoda, R. (1984). The use and costs of Medicare services in the last 2 years of life. UK Pubmed Central. 5(3): 117-31. Web. 

This article appeared in Pub Med journal in the UK. The authors were reporting on the use of services by Medicare enrollees who died in 1978. Decedents comprised 5.9 percent of the study group but accounted for 28 percent of Medicare expenditures. Despite the idea that heroic efforts to prolong life are common, only 6 percent of persons who died had more than $15,000 in Medicare expenses in their last year of life.

Riley, G. F., Potosky, A. L., Lubitz, J.D. and Kessller, L. G. (1995). Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. UK Pubmed Central. 33(8): 828-41. Web. 

This article carries out an analytical outlook at the cost incurred in treating various forms of cancer in elderly patients from diagnosis to death. The aim was to identify and compare the difference in cost on the Medicare program among patients whose cancer infections were diagnosed early and those diagnosed late. The article provides data on Medicare payments subsequent to the diagnosis of cancer.

Harlan, M. et al. (1997). Re-admission after hospitalization for Congestive Heart Failure among Medicare Beneficiaries. Arch Intern Med. 157(1): 99-104. Web. 

This investigative article appeared in the Arch Intern Med Journal. The authors evaluated re-admission and death among all survivors of hospitalization in Connecticut for congestive heart failure from the fiscal year 1991 through to the fiscal year 1994 among Medicare beneficiaries. The authors argue that a striking rate of re-admission in a common diagnosis demands efforts to further clarify the determinants of re-admission and develop strategies to prevent this adverse outcome.

Shugarman, L. R., Bird, C. E., Schuster, C. R. and Lynn, J. (2002). Age and gender differences in Medicare expenditures at the end of life for colorectal cancer decedents. Journal of Women’s Health. 16(2):214-27. Web. 

This website archive article provides an analysis of the gender differences and their ratio expenditure from the Medicare program. Age as a factor has also been included in the analysis.

Elliot, S. et al. (2004). The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care. Annals of internal medicine. 138(4): 273-287. Web.

This article is a product of the health care Quality Improvement Program that was carried out by the Medicare services center in an effort to identify areas of improvement through the analysis of patient care patterns. The article carries the opinions of the authors and welcomes ideas from external stakeholders. It explores the regional differences in expenditures under the Medicare program through in-patient observations. The authors conclude that the quality of Medicare services does not necessarily look better even in high spending areas.

Ordin, D. L., Masoudi, F. A., Havranek, E. P. and Krumholz, H. M. (2000). Medicare Initiatives to Improve Heart Failure Care: An Introduction. Congestive Heart Failure, 6: 280–282. Web. 

Wiley online library is a database with articles from various authors. This article, written under the guidance of Diana Ordin, addresses the challenges faced by heart patients who form a majority under the Medicare program. The article is among the many written by the same authors aimed at initiating discussions on the efforts at the national and private levels to address these challenges.

Legal and Political Dimensions on the Medicare Program

Nelda, M., Harriet, L. K., Andrew, P. and Stanley, M. (2001). Medicare Home Health Before and After the BBA. Health Affairs. 20(3): 189-198. Web. 

This website deals with health and all legal issues surrounding the same. The above mentioned is an archived article on the effect of a law passed in 1997 regarding the Medicare program. The Balanced Budget Act (BBA) introduced changes in an effort to control spending and improve efficiency in the delivery of personal health care. The authors describe the modifications proposed by the law on the program and their long-term impact especially in areas of eligibility, payment systems and coverage rules.

Andrea, L. C. (2004).The Political Life of Medicare. Journal of Health Politics, Policy and Law. 29(6): 1238-1241. Web. 

This article is a review of the political aspects of the Medicare program in the post-founding period. The article incorporates Congressional hearings, scholarly discussions and analyses, and government reports on the program. The principles of the program are well described since its inception to date.

Edwin, P., Melanie, N., Robert, G. and John, S. (2003). Key Issues in Medicare Prescription Drug Legislation. Web. 

This website on the Medicare series provides an analysis of the issues surrounding the Medicare prescription drug legislation both in terms of fiscal policy and health concerns. The website examines all statements made in several newspapers concerning the new piece of legislation. The analysis concludes that the proposal to merge financing for the program entirely may result in insolvency problems.

Jonathan, O. (2007). Through the Looking Glass: The Politics of the Medicare Prescription Drug, Improvement, and Modernization Act. Web. 

This site has numerous articles on policy issues surrounding national health insurance programs. Jonathan Oberlander, a political scientist, explores the policy and political dimensions of the 2003 Medicare Prescription Drug, Improvement, and Modernization Act (MMA), and its effects on future reforms.

Gonzalez, J. (2011). Medicare: where do we draw the line? Web. 

This blog has been posted on the red state website. The author describes the constitutional and political intrigues surrounding the Medicare program. His analysis spreads from the economic aspects to political and social elements of the program.

Lott, J. (2011). “Even Politifact says Attacks on Ryan Medicare proposal named ‘lie of the year’”. The Hill Newspaper. Web. 

This blog was posted on John Lott’s website and is an opinion article on the politics surrounding proposed amendments on the national health insurance programs such as Medicare. He clarifies that the notion that the Republicans would abolish the program upon assuming power is misplaced.

Quality Issues and challenges regarding the Medicare Program

Stephen, F. et al. (2000). Quality of Medical Care Delivered to Medicare Beneficiaries. JAMA. 284(13): 1670-1676. Web. 

This site has numerous expert analysis information regarding health issues. It falls under the Journal of the American Medical Association. The authors give a detailed outline of the quality of medical care provided under the Medicare program. Their findings cover areas of clinical performance measures and the services on offer in the health insurance field. Recommendations to improve Medicare and reach the beneficiaries in a quality way are given. A call on partnership creation among health care providers in the private and public sectors is given in an effort to achieve an all-around improvement.

Lawrence, D. and Andrew, D. (1998). The Challenge to Improve Quality of Care. Jama. 279(13): 992-993. Web. 

This editorial by Dr.Lundberg appeared in the Journal of the American Medical Association and mentions the specific challenges that the Medicare program may face in an effort to improve the health of the American people. It mentions high prevalence and high impact medical conditions as the main focus areas.

Christine, L. (1995). The Health Care Quality Improvement Program: A Move towards More Effective Peer Review Organizations. Health Policy Newsletter, 8(3): 5. Web. 

Thomas Jefferson university’s website carries this article. Christine Laine, an assistant professor of medicine in the center for research in medical education and health care at the university, attempts to offer inductive insight into the improvement of the Medicare program through the use of state peer review organizations (PROs) that act as an eye for the government in assessing the performance of hospital administrators as outlined in the Medicare program blueprint.

Stephen, F., Edwin, D. and Timothy, C. (2003). Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998-1999 to 2000-2001. Jama. 289(3): 305-312. Web. 

This journal article questions the quality of parameters used by the Medicare Quality Improvement Organization (QIO) program as mandated to improve the Medicare health program in the US. This is because only limited data exist on the same.

David, B.N. (1995).Quality of Measurement or Quality of Medicine? Jama. 273(19): 1537-1538. Web. 

The Jama website carries this article which gives information on the model used to review the effectiveness of the Medicare program. It indicates that quality improvement action plans by hospitals in America should give the right feedback on their actual performance.

“CMS Provides Health Coverage for 100 Million People.” CMC News. Web. 

This website belongs to the Centers for Medicare and Medicaid Services (CMS) and gives information on successes, challenges, and efforts of CMS in the provision of healthcare services to the American populace, through among others, the Medicare program.

Health and Drug Plans. (n.d.) The official U.S. Government Site for Medicare. Web. 

This government website gives information regarding the health care program. This involves the cumulative cost of the program; the plans under the program; the services available under the program; the working structure of the Medicare program; the interrelationship of the program with other private insurance programs and other coverage choices; eligibility and enrollment; and how to make claims and information on Medicare supplier diary.

Jane, G. (2011). How Medicare Fails the Elderly. Web. 

This blog was posted on the Medicare benefits website. Jane Gross is the author of “A Bittersweet Season: Caring for Our Aging Parents — and ourselves.” In her article, she reveals the deterioration in quality provision of the Medicare program since its inception in 1965.

Group LLC. (2011). 2012 Medicare Part D – Enrollment Options. Web. 

This website gives an elaborate coverage of part D of the Medicare program. Part D of the program was added in 2006 following an Act of parliament: the Medicare Prescription Drug, Improvement and Modernization Act. According to this provision, any Medicare beneficiary is mandated to enroll in a prescription drug plan (PDP). This coverage is not standardized and can be administered even by privately owned health insurance firms. These firms cover different classes of drugs according to the financial ability of the clients.

John, R. and Christopher, P. (1997). How Social Security and Medicine Affect Retirement Behavior in a World of Incomplete Markets. Econometrica.65 (4): 781-831. Web. 

This article describes in detail the labor supply of the U.S. is affected by the social security and Medicare insurance system in the presence of incomplete loan markets and health insurance. It is based on research data on elderly males in the low and middle-income brackets who only have social security as their source of pension. The article identifies a significant fraction of “health insurance constrained” individuals who have no form of retiree health insurance other than Medicare.

Warren, J., Klabunde, C., Schrag, D., Peter, B and Riley, G.F. (2002). Overview of the SEER-Medicare Data: Content, Research Applications, and Generalizability to the United States Elderly Population. Medical Care, 40(8): 3-18. Web.

The Surveillance, Epidemiology and End Results (SEER) website provides Medicare data in relation to population-based information in areas of cancer treatment and the costs involved. The article provides an in-depth analysis of the status of the health sector in the US, particularly among the aged. The data availed by the article from research carried out by SEER gives insightful information on the successes and shortcomings of the program.

Julie, A. et al. (1999). Health Literacy among Medicare Enrollees in a Managed Care Organization. Jama. 281(6): 545-551. Web. 

This article describes the challenges that elderly patients face in an attempt to comprehend the demands of the program. Most elderly people with literacy problems may not make decisions as they lack a comprehensive understanding of the model. In an analytical format, the article gives detailed data on percentages of the elderly who can not understand English clearly. The author claims that the low literacy skills among the elderly enrollees may act to deny them access to benefits accrued from the Medicare program.

Senior-journal. Medicare News for Senior Citizens. Web. 

The senior journal website runs articles written by various experts on issues affecting senior citizens in the US. The Medicare, Medicaid and other insurance reforms undertaken by the US government are well explained. All archive articles on these issues are outlined chronologically since the inception of these programs; the amendments effected; and the emerging trends and challenges affecting these programs.

RX Journals. (2007). Medicare to add coverage. Web. 

This website of RX has health and medical news aimed at providing information that promotes better living standards. Articles on the coverage of Medicare beneficiaries are displayed. Among these are preventive obesity counseling and tobacco cessation counseling.

Hobson, K. (2011). A.M. Vitals: States Can Decide on Essential Benefits for Health Plans. Web. 

This website has many blog posts on health and medical issues in America. Katherine Hobson’s blog is a study of health care plans initiated by the U.S. government over the years, their implications on the social lifestyles, and economic impacts on the beneficiaries. She provides an analysis of the Medicare program among others.

Rural Assistance Center. (2011). Medicare Part D Prescription Drug Benefit. Web. 

This website covers health and medical issues affecting the rural populace in the US. It contains thousands of articles by health, political, economic and social experts on impacts that national health program has on the populace, and in particular, the effects on the majority of rural inhabitants. The articles range from advocacy to analysis of the programs’ influence on the rural fork lifestyles. The issues surrounding the Medicare program are well explained on the website.

Smith, M. (2010). FAQ: Medicare and Veteran Benefits: How do Medicare Advantage policies coordinate benefits with seniors who also have VA benefits? Web. 

This website contains numerous articles. Health and medicine are discussed in detail in various articles here. Mike Smith, a Medicare expert, describes the impact of the Medicare Advantage model. He explores all issues regarding parts A, B, C, and D together with their interrelationships. The website also gives a platform for expert advice on any issues regarding the Medicare program through a question-answer model. This provides an elaborate analysis of the issues relating to the Medicare program.

Moon, M. (2000). “Competition with Constraints: Challenges Facing Medicare Reform.” Urban Institute. Web. 

This article is a research paper tackling the constraints faced by private and public policymakers in an attempt to address emerging challenges in the 21st century regarding health. The urban institute researchers have assessed how the existing policy on retirement, demography, and private practice influences the economy, the elderly, and the government budgetary allocations. The article outlines the integration of health matters and income trends, providing objective, incisive and non-partisan data on the challenges faced by the aging population. There are more details that can be found on the urban institute’s website.

General Overview on the Medicare Program

Sheri, I. (1985). Medicare. Web. 

This website is an online research library with information on various issues and topics. The information on Medicare, which serves as the national health insurance program in the US, is available as discussed by various authors. Sheri describes the structure of the program; the amendments carried out on the program; and their effects on the provision of health insurance to the elderly American populace.

Alder, G. S. (1994). A profile of the Medicare Current Beneficiary Survey. Pub Med. 15(4): 153-63. Web.

This article in the Pub Med journal provides the methods and the logic behind the Medicare program. The survey provides valid estimates on the spending under the program. It also describes the ultimate effects and results of the program on its beneficiaries. In this article, sampling, analysis, and data collection methods are outlined. A unique format using Computer-Assisted Personal Interviewing (CAPI) is used in the survey encompassing community and residential facilities, as well as administrative data.

Health Insurance Leads. (n.d.) Medicare and other health insurance programs. Web. 

This website owned by Norvax has information on the US health insurance industry. On a monthly basis, the website avails information on more than two hundred thousand health, life and Medicare leads. The networked website links agencies and carriers. The website provides various high-quality internet-based insurance directions to various interest groups.

Gillispie, A. (2011). Health information literacy-for health and well-being. Web. 

This blog contains medical news and health information, and any other resources for parties concerned. The website also offers extra links and references for further reading. Public health and research on lifestyles have been given more attention. Information on Medicare, Medicaid, and the affordable care programs among others have been highlighted and expounded on to give the reader and interested parties an insightful overview.

The Extend Health Blog. (2011). Insights into retiree health care trends and innovations: Ryan and Wyden Medicare proposal overview and news roundup. Web. 

This blog was posted on the website and discusses health matters such as health insurance plans including Medicare, Medicaid and the Affordable Care Act, 2011. News roundup and opinions concerning various health-related issues are posted. A December 16, 2011 article on Ryan and Wyden’s Medicare proposal to overhaul Medicare presents the latest in the looming amendments in one of the nation’s oldest national health insurance programs. Opinions concerning the proposals are also posted on this site.

Bird Island Partners (2011). Need Information On Medicare Insurance Plans? Web. 

This website gives information on the Medicare program. It explains how to enroll, benefits, Medicare Advantage, supplemental insurance or “medigap”. The website makes an effort to make all information regarding the program easy to access and read. This promotes public awareness of health-related issues including the Medicare program.

Bernstein, J. and Stevens, R.A. (1999). Public opinion, knowledge and Medicare reform. Health Affairs. Web. 

This article gives public opinion and research data comparisons in an effort to demonstrate the deviation in the public understanding of the Medicare program from the actually available information. It discusses policy issues and the knowledge-based understanding of the larger society. Therefore, the content of the article is critical to the analysis of health issues.

Hoyer, T. (1998). A History of the Medicare Hospice Benefit. Web. 

This website contains numerous materials on various world topics. The Medicare program history is discussed in detail here. Hoyer describes the challenges of operating the program including communication constraints.

Hammond, J. (1979). Home health care cost-effectiveness: an overview of the literature. Public Health Rep. Public Health Rep. Web.

This website provides articles and external links on general information concerning the Medicare program. Hammond, a program analyst, gives insightful details concerning the Medicare program, as well as other programs such as Medicaid and private health insurance programs.

Feder, J., Komisar, H.L. and Niefeld, M. (2000). Long-term care in the United States: an overview. Web.

EBSCO Host is an online database with numerous articles covering a range of topics in different fields. This article describes the importance of incorporating long-term care in the US health care programs such as Medicare and Medicaid. The author outlines the need to formulate policies to cater to the long-term health issues of the program beneficiaries.

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