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The United States health care system is larger than the gross domestic product of all but five other nations.

Over the past several decades, health care costs have outpaced economic growth, inflation and personal incomes. A consensus exists across ideological and partisan divides that: 1 as a nation, we are not getting what we pay for when we spend as much as we do on health care, and 2 health care spending growth in the United States is on an unsustainable path. Numerous problems come from such a large, costly and growing health care system. Americans fortunate enough to have employer-sponsored health insurance increasingly are paying more of their premiums or are seeing their wages stagnate as their employers pay higher premiums.

As the search for solutions continues, it seems clear that there is no magic bullet. Adopting policies that simply cut benefits or limit provider payments might leave the system better off in a strictly fiscal sense but could severely reduce access to quality care. Similarly, raising new revenues to fund the current system or expand coverage to more of the uninsured are important but do nothing to control health care inflation over the long term or improve the value of services received.

In the end, it will take a mix of strategies to bring health care costs down to a sustainable level while improving quality and value. The federal government subsidizes the health care of most American adults in a variety of ways, depending on their age, military service, employment status, income and health. The majority of Americans have employer-based coverage, which is subsidized through preferential tax treatment. Middle- and lower-income individuals who do not have access to employer-provided health insurance are eligible for tax credits under the Affordable Care Act that enable them to purchase individual plans on the private market.

The rest of the insured are covered directly through government-run insurance programs. Of these programs, the government spends the most on Medicare. It provides health insurance for nearly all Americans over 65 as well as workers who have become disabled. It is available regardless of income, although higher-income individuals have higher premiums. If necessary, SSA will send the form to the facility to correct the date s.

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A Primer on Medicare – What is Medicare? – Sec 1 – | The Henry J. Kaiser Family Foundation

To be currently insured , the person with ESRD or spouse or parent must have at least 6 credits in the 13 calendar quarters before disability e. Definitions of these relationships follow:. If older than age 22 and disabled, the disability must have started before age The month the patient is a hospital inpatient to prepare for kidney transplant surgery if the surgery occurs within 2 months.


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The 2nd month prior to a transplant if procedures in preparation for a transplant took place as a hospital inpatient more than 2 months prior to that transplant. Some ESRD patients choose to delay enrolling in Medicare if they have employer group health plan coverage. Having a new IEP can:.

Provide an earlier Medicare effective date than Medicare due to age or disability;.

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They are supposed to explain these choices:. Delay enrolling in both Part A and B until the end of the month coordination period. However, Medicare claims paid, if any, must be reimbursed.

The Health of Older Americans: A Primer on Medicare and a Local Perspective

Withdrawal of application can help avoid patients having to wait to enroll in Part B during the general enrollment period, and a higher premium. A Medicare application can be backdated up to 12 months.


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Note that withdrawing the application for Part A can affect Part B coverage of immunosuppressants if Part A was not in effect the month of the transplant. A patient could use Part D for immunosuppressants—but this may cost more, unless the patient has other insurance.

What is the Medicare Part D prescription drug benefit?

Some people who get monthly Social Security retirement or disability benefits ask to waive Medicare Part A because of religious or philosophical reasons or because they prefer other health insurance. The only way recipients of monthly benefits can waive Medicare Part A is to withdraw applications for Social Security retirement or disability and repay all Social Security retirement or disability benefits and pay back any Medicare Part A payments.

If someone who works for Social Security provides incorrect advice, it can be costly. Requesting equitable relief provides recourse for the patient.

The Health of Older Americans: A Primer on Medicare and a Local Perspective.

Patients who in enroll in Medicare Part A and B together or delay enrolling in both until the month period ends have no coverage gap or higher premium. Getting cash under Section includes Medicare, Medicaid, and a State Supplement where applicable and continues until:. Patients who get SSI under Section must still meet income and resource limits. They can use such SSI work incentives as impairment related work expenses, blind work expenses, and student earned income exclusion.


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Someone with a disability who loses SSDI cash due to work can keep Medicare Part A for free for 93 months after they have used all 9 trial work months. A transplant patient who works with another disability besides ESRD can use this work incentive. Dialysis patients do not risk Medicare by working. Social Security policies are complex and time consuming to read and understand. I hope this description will help you help your in-center and home dialysis patients get the benefits they need and deserve.

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