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Policy Formulation in Medicare

1. Summarize and synthesize the most recent Medicare related legislation. What impact this will have on the involved stakeholders (i.e., patients, providers, third-party payers).

2 . Provide a forecast for Medicare Reform
Include a prediction of how this Medicare legislation will impact the life of the Medicare program.
propose at least 1 change to the current Medicare legislation that will extend the life of the program beyond 2026.


Solution Preview

Since its inception in 1965, Medicare has been providing social insurance for Americans aged 65 and older and has expanded its coverage to younger people with disabilities and people with end stage renal disease and ALS. This article from Wikipedia provides a comprehensive overview of Medicare's history, recent legislation, and issues on funding and sustainability:

The three most recent Medicare related laws include the Balanced Budget Act of 1997; the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; and the Patient Protection and Affordable Care Act of 2010.

Prior to 1997, Medicare coverage included Part A for hospital and inpatient services and Part B for outpatient care and physician visits. The Balanced Budget Act of 1997 allows beneficiaries to avail of "Medicare+Choice" or Part C plans, in which they receive their Part A and B benefits through private health insurance plans. This means that members can opt for additional benefits not covered under traditional Medicare such as dental care, vision care and gym or health club memberships by paying an additional monthly premium. In exchange, the patients' choice of providers is typically limited within the network provided by insurance plans; going outside the network may incur additional fees.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 allows for the inclusion of ...

Solution Summary

This solution provides a summary of recent Medicare legislation and suggestions on how to extend the life of the program.