Major Components Of Medicare

Medicare consists of several key components designed to provide healthcare coverage primarily to individuals aged 65 and older, as well as younger individuals with specific disabilities. One major component is Medicare Part A, which covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. However, significant coverage gaps exist. For example, Medicare Part A does not cover long-term custodial care, which leaves many elderly patients without financial support for extended nursing home stays. Additionally, its home health services are limited to intermittent skilled nursing care, creating challenges for patients needing long-term in-home assistance (Austin & Wetle, 2017).

Major Components of Medicare

Another critical component is Medicare Part B, which provides coverage for outpatient services, preventive care, and physician visits. Despite its broad coverage, Medicare Part B has notable gaps, such as the exclusion of routine dental, vision, and hearing services. This omission affects many elderly patients who require these services to maintain their overall health. Furthermore, Part B requires monthly premiums, deductibles, and 20% coinsurance for most services, leading to high out-of-pocket expenses for lower-income seniors (Mason et al., 2021).

Medicare Part D, which offers prescription drug coverage through private plans, is another essential component. Despite its role in reducing medication costs for beneficiaries, there are still significant coverage gaps. One such gap is the “donut hole,” a coverage limitation that results in higher out-of-pocket costs for beneficiaries who exceed a certain spending threshold. Although recent policies have attempted to minimize this issue, some patients still face financial burdens. Additionally, Medicare Part D does not cover over-the-counter medications or many specialty drugs, leaving patients with chronic conditions facing high medication costs (Austin & Wetle, 2017). Medicaid serves as a vital healthcare program for low-income individuals, families, pregnant women, and individuals with disabilities. One fundamental component of Medicaid is its mandatory benefits, which include hospital services, physician visits, and nursing home care. However, coverage gaps exist, such as limited dental and vision services for adults. Because Medicaid coverage for these services varies by state, disparities arise in access to necessary preventive care. Additionally, some states enforce strict eligibility requirements, leaving many low-income adults without children ineligible for coverage (Mason et al., 2021).

Another key component of Medicaid is Home and Community-Based Services (HCBS), which allows individuals with disabilities and elderly patients to receive long-term care in their homes instead of institutional settings. However, many states have lengthy waiting lists for HCBS waivers, delaying essential care for vulnerable populations. Furthermore, coverage inconsistencies exist across states, leading to unequal access to in-home support (Austin & Wetle, 2017).

Medicaid expansion under the Affordable Care Act (ACA) is another significant component, allowing states to extend Medicaid eligibility to low-income adults up to 138% of the federal poverty level. However, not all states have chosen to expand Medicaid, leaving many low-income individuals without access to affordable healthcare. Additionally, in states with limited postpartum Medicaid coverage, some new mothers lose their benefits just 60 days after childbirth, leaving them without essential maternal healthcare (Mason et al., 2021).

Social Security

The Social Security program is a crucial financial safety net for millions of Americans, particularly retirees, individuals with disabilities, and survivors of deceased workers. Given its importance in reducing poverty rates among the elderly and disabled, I believe the program should be modified rather than eliminated or left unchanged. According to the Social Security Administration, nearly 40% of retirees rely on Social Security for the majority of their income. Without it, millions of seniors would face financial insecurity (Austin & Wetle, 2017).

To ensure the program’s long-term sustainability, several modifications could be implemented. One potential change is increasing the payroll tax cap. Currently, only wages up to $168,600 (as of 2024) are subject to Social Security taxes; raising this cap would generate additional revenue without impacting lower-income earners. Additionally, gradually increasing the full retirement age could help balance the system as life expectancy continues to rise. Another potential reform is means-testing benefits so that high-income retirees receive reduced benefits, ensuring that Social Security remains focused on those who need it most (Mason et al., 2021).

References

Austin, A. & Wetle, V. (2017). The United States healthcare system: Combining business, health, and delivery (3rd ed.). Pearson.

Mason, D., Dickson, E.L., Perez, G.A., & McLemore, M. (Eds.). (2021). Policy & politics in nursing and healthcare (8th ed.). Elsevier.