In the recent years, the government of United States has embarked on reviving Medicare, which is a unique program of social insurance providing the best health insurance mainly covering citizens aged 65 years and above, those less than 65 years and are physically disabled and other citizens having special needs. “Medicare is administered by a Government body known as Centers for Medicare and Medicaid Services(CMS) which oversees the overall implementation of Medicare laws” (Joseph & Dorothy, 2011). With many challenges faced by Medicare, the U.S. government has aggressively tried to control spending on healthcare using Medicare.
The latest attempt to salvage extinction of Medicare by 2026 was an Act passed in 2003 referred to as ‘The Medicare Prescription Drug, Improvement, and Modernization Act’. Medicare is generally grouped into two major categories namely: the “Medicare Advantage Plan” and the “Original Medicare Plan”. Each category comprises four main sub-categories referred to as Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medical Advantage Plans) and Part D (Prescription Drugs plans). Recently, Medicare has undergone through a number of legislations that have distinct impacts on the involved stakeholder namely patients, medical providers, and third-party payers.
The long-debated legislation reform on healthcare became law in 2010 by signing of the ‘Patient Protection and Affordable Care Act (H.R.3590)’, and The Health Care and Education Reconciliation Act (H.R. 4872). The passing of these legislations into law had diverse impacts on the various stakeholders involved. First portions of this law will affect Part D of Medicare plan for description on drug plan for seniors and for other patients eligible in Medicare by closing the wide coverage mostly referred to as the doughnut hole. Patients will benefit from this law because its provisions state that from 2010, patients whose their drug costs get to the set coverage gap will receive a refund worth $250. The third-party payers will be impacted negatively because the law will result into increased premiums especially for the high–income earners.
In addition, president Obama on 23rd March signed into law the famous Patient Protection and Affordable Care Act. This Act made important changes to the Medicare Part A and part B. The patients will receive benefits .For instance, the act provides free Medicare of part A to the patients exposed to detrimental asbestos in Montana at the Lincoln County. These patients will be given free chance to enroll to the part B and part D Medicare coverage. However, the individuals must prove to have been clearly diagnosed with a disease, which is asbestos-related. In addition, this Act on Affordable Care makes good changes to Part B Medicare enrollment, as it will allow easy enrollments to part B with no increased premiums payments. Premiums paid by the third-party payers will increase to cater for the increased costs of this program.
Furthermore, the Medicare Improvements for Patients and Providers Act (MIPPA) that was enacted into law in 2008. This law was beneficial to patients as it changed the current laws on Medicare in order to assist the low-income patients and other beneficiaries (Leonard, 2008). The third-party payers will experience increased participation into the Savings Programs for Medicare. This is because, “every year, the Medicare beneficiary costs increase thus raising coinsurance amounts and other deductibles to cover the ever-rising cost of this program” (Marsh, 2008). In addition, monthly premiums also rises thus affecting the third-party people which can spell many hardships especially to senior and fixed income earners. Providers of health care will receive increased funding because of this implementation. This law increased rates of payments for the physician’s services. The providers will experience improved and effective means of health claims payment. In addition, providers will experience reduced bureaucracy in payments of health costs.