Mr. Wilson, I will be presenting to you a summary of the health care system and the social
determinants of health, with the goal of helping you decide which of these we should focus
on as a company. I believe we should keep company focus on the health care system
because it applies more to us as a business than social determinants. I will be discussing
why I think that is in my conclusion.
Health Care System
Medicare
Medicare is a national health program for all people age sixty five or older who are eligible
for Social Security. It was enacted by Congress in 1965 as a social insurance program that
granted automatic rights to all qualified workers and their spouses. Medicare consists of
four parts:
Medicare Part A – is hospital insurance paid for through payroll taxes. It covers your stay
in a hospital for up to 90 days. Plus you are given a one-time supply of up to 60 reserve
days that are almost completely covered by Medicare besides a fee of $952. Medicare part
A also pays for nursing home care if you were in the hospital for at least three days.
Medicare Part B – pays for eighty percent of the cost of physician office visits. It also pays
for some wheelchairs, oxygen, walkers, and some diagnostic tests. Part B costs $88.50 a
month plus a deductible of $124 a year.
Medicare Part C – also is called Medicare Advantage, has plans that include health
maintenance organizations (HMOs) that often help grant extra benefits and lower
co-payments.
Medicare Part D – is a benefit which added a prescription drug benefit to Medicare. It pays
75% of costs up to $2,500 each year. This benefit has a “doughnut hole” approach in which
after that first $2,500 no costs will be covered until you spend another $3,600 ($6,100
total) out of your pocket, but if you go beyond that threshold then Medicare pays 95% of
all costs.
Medicaid
Medicaid was established the same time as Medicare but it is a program of health
insurance for the aged, blind, and disabled poor. Its main difference from Medicare is that
only those with very low incomes are eligible for Medicaid. “Medicaid pays for a variety
of health care services, including acute care services, hospitalization, diagnostic testing,
physician visits, and prescription drugs.” What also makes Medicaid different from
Medicare is that it pays many of the costs Medicare does not cover, even nursing home
care.
Support for the Disabled
