Question

• Provide an overview—and discuss the function—of 1 publicly financed health care program in the United States.
• How has that program evolved and influenced the entire U.S. health care system?
• What are some of the accomplishments and challenges for that program?
• What does that program do to focus on health prevention and performance?

Answer 1

MEDICARE:Medicare is 100 percent federally financed and operated, health care services are delivered almost entirely through the private sector.Medicare provides health insurance to all individuals eligible for social security who are aged 65 and over, those eligible for social security because of a disability, and those suffering from end-stage renal disease (ESRD).

Benefits

Basic acute care coverage, some preventive; high cost sharing, no prescription drugs

Comprehensive for both acute and chronic care plus institutional long-term care for the elderly, disabled, and mentally retarded; nominal cost sharing

Eligibility	Eligibility for social security, (age 65 and over, end-stage-renal disease, or disabled)	Percent of federal poverty level and eligibility category (e.g., children, pregnant women, disabled)
Challenges	Integrating CMS changes to Medicare and Medicare benefit plans and staying compliant is an ongoing challenge for health plans.	Processing dual-eligible claims for Medicare and Medicaid are costly and complex, as the claims and reimbursements must be correctly allocated.

Medicare is a big business that has shaped the U.S. healthcare system for decades. In 2015, Medicare benefit payments totaled $632 billion — 23 percent was for hospital inpatient services, 12 percent for the Part D drug benefit and 11 percent for physician services. Twentyseven percent of benefit spending went toward Medicare Advantage health plans.