To begin with, the basics! Medicare is a government built health
insurance which is aimed at the 65+ population within the United
States (Cotton et a al., 2016). Medicare was originally started in 1965
and still continues to this day (Cotton et al., 2016). The plan offers
multiple types of coverage for those who qualify.
a a A primary advantage to Medicare is that it offers a range of
coverage to a particularly vulnerable population. This population may
be more likely to have co-morbidities and have medical concerns.
Medicare is not technically free, but is paid through taxes a person
pays in their lifetime (Cotton et al., 2016). Medicare can help cover
for low fees- $0 premiums for seniors who are in poverty, low income
or financially unable to pay other ways. a Medicare offers coverage of
not only primary prevention, but helps cover chronic conditions
(Cotton et al., 2016). Medicare also helps with drug costs! This helps
increase the amount of population seen. This group has specialists
dedicated to it. It also helps create and keep jobs to keep up with the
demand of healthcare professionals and centers/ hospitals to see
these clients. Another benefit is Medicare will also work if a patient
has a separate private insurance (Meyers & Johnston, 2021). This
means a patient will have more options for coverage as they see
necessary. This benefits healthcare overall as a patient may be more
likely to see a provider and will have financial means to pay for it. A
final benefit is that the medicare coverage is not a one size fits all,
there are different options so a person can decide what meets their
needs best financially and/ or if they have other insurance coverage
(Meyers & Johnston, 2021).
a a It should be noted that Medicare is not perfect though. One
main challenge of medicare is the limited network (Lipschultz, 2019).
Many who use Medicare as a primary are limited in who they can see,
and may end up having to pay high out of pocket fees if specialists are
needed (Lipschultz, 2019). This is a challenge for healthcare overall as
they may be unable to serve a portion of the population. Another
issue is, despite wide range of coverage plans, it may cost more in
copays and deductibles (Lipschultz, 2019). Depending on the plan
selected, or if a person is stuck within a plan for a time, the copays
and deductibles can be a higher price than a person can pay. It should
be noted that monthly premiums often appear low, but most of the
money paid comes from these deductibles, copays and out of pocket
costs which can add up quickly (Arvantes, 2019). A patient may be
unable to pay and healthcare corporations may have to ‘eat the cost’.
Medicare can and will deny payment of certain treatments or services
making a financial dilemma for many healthcare agencies (Arvantes,
2019). A main challenge many of you may know is that Medicare will
not pay for HAI’s or hospital acquired injuries. This is a major
challenge as some of the infections, despite best practice efforts can
still happen.
Cotton, P., Newhouse, J. P., Volpp, K. G., Fendrick, A. M., Oesterle, S.
L., Oungpasuk, P., Aggarwal, R., Wilensky, G., & Sebelius, K. (2016).
Medicare Advantage: Issues, Insights, and Implications for the Future.
Population health management, 19(S3), S1–S8.
https://doi.org/10.1089/pop.2016.29013.pc
Lipschutz, D. A. (2019). Commentary: Don’t Further Privatize
Medicare. INQUIRY: The Journal of Health Care Organization, Provision,
and Financing. https://doi.org/10.1177/0046958019867612
Meyers D.,, & Johnston K.. The Growing importance of medicare
advantage in health policy and health services research. JAMA Health
Forum. 2021;2(3):e210235.
doi:10.1001/jamahealthforum.2021.0235
Arvantes,J. (2021, December 9). Top advantages & disadvantages of
medicare advantage. Value Penguin.
https://www.valuepenguin.com/advantages-disadvantages-
medicare-advantage
