Medicare Program Eligibility and Coverage

Medicare Eligibility and Financing Paper
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Medicare Eligibility and Financing Paper
Introduction
Medicare is a medical insurance plan provided by the federal government. It was established in 1965 specifically for older adults aged 65 and above, regardless of their health history, medical status, or income level. The program was scaled-up in 1972 to include younger individuals under 65 years suffering from long-term disability. Medicare plays a significant role in offering over 60 million older adults financial and health security, including younger individuals living with disabilities. The program assists its beneficiaries in accessing health care services, including prescription medications, hospitalizations, preventing services, doctor visits, skilled nursing facilities, as well as hospice care, and home medical care. This report investigates who can be a Medicare program beneficiary, the financing of the program, including specific rules that should be adhered to qualify for funds reimbursements, and how the program reimbursement levels compared to average private insurance reimbursement specifically, as well as how such a discrepancy impacts my facility’s bottom line.
Investigation of the Medicare Program Eligibility and Coverage
Medicare is a medical coverage plan for individuals aged 65 and above, younger individuals aged below 65 with specific disabilities, and those with permanent kidney failure (Centers for Medicare and Medicaid Services, 2019). Medicare program is categorized into parts A, B, C, and D. Individuals aged 65 and above and who are permanent residents or citizens of the United States (U.S.) qualify for Medicare Part A (also referred to as hospital insurance). An individual is eligible for Part A at no cost at 65 years when they meet one of the following criteria: (a) they are eligible or receive the Railroad Retirement Board (RRB) or Social Security benefits, (b) the spouse (deceased or living, including divorced), is eligible or receives RRB or Social Security benefits, (c) a person or their spouse served in government office long enough via which they paid Medicare taxes, and (d) a dependent parent of a wholly covered deceased child (Social Security Administration, 2022). If one of the following criteria applies, an individual younger than 65 is eligible for Medicare Part A: (a) individuals who can receive Social Security Insurance (SSDI) benefits for two years, (b) those receiving RRB disability pension and satisfying other conditions, (c) those receiving SSDI benefits due to their amyotrophic lateral sclerosis, (d) those who served in government office long enough via which they paid program taxes and meets SSDI program requirements for two years, (f) a widow(er) or child aged fifty or above, including divorced widow(er) of a worker qualifying for Social Security or Medicare Coverage, and (g) individuals suffering from kidney failure in need of kidney transplant or are receiving dialysis (Social Security Administration, 2022).
Any individual who qualifies for Medicare Part A at zero cost can also be a Medicare Part B beneficiary by paying monthly premiums without procuring Part A. Individuals wi...