Since early 1990s health care issues have been a major concern in the United States. As early as in 1915, various agencies embarked on ways of establishing government health insurance programs (National Academy of Social Insurance Study on Medicare and Disparities, 2006). Since many United States citizens found it very difficult to cope with the high amounts of medical costs that they could neither predict nor afford, there was a consensus to establish a health insurance from 1930s. The major concern was whether the program should be funded using public or private finances.

During World War II, when the United States government increased its limits on direct wage which led to an increase on fringe benefits, many people opted for private health insurance. This continued even after the war. Most middle income earners longed to join private health insurance but could not afford. This made them seek support from the government.

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The American Congress, with the help of taxes received through payroll, proposed and planned various health insurance programs but none was voted (David, 1985). After many proposals, considerations and lengthy debates, Congress passed a bill that created the Medicare program as Title XVII of the Social Security Act in 1965.

In 1965 an amendment was made to the Social Security Act which established part A, the compulsory Hospital Insurance (HI), and part B, the voluntary program of Supplementary Medical Insurance (SMI) of the Medicare program (Corning, n.d.). Various amendments have been made which have included certain disabled people under the age of 65 and people of any ages with a certain kidney disease. Since 1977 the responsibility of managing Medicare has been left to the Health Care Financing Administration (HCFA). The two parts of Medicare (Health Insurance and Supplementary Medical Insurance) are financed by two trust funds which are funded differently.

Medicare is a United States’ health insurance program initially designed for people aged sixty five years and above (Social Security Bulletin, 2000). Nowadays it includes people younger than sixty five with disabilities and people of all ages with permanent kidney failure that requires a regular course of dialysis or kidney transplant.

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Those who are 65 and above qualify for Medicare if they fulfill the following requirements: must be legal residents of the United States or have resided in the United States for a period of at least five years, applicant or spouse have worked in Medicare-covered job for a period of ten years and above (Kingson & Berkowitz, 1993) and have Social Security deductions removed from their salaries automatically qualify for Medicare (Extend Health, 2011). Those who do not received Railroad Retirement Benefits or Social Security payments and those who were government employees can also qualify for Medicare.

United States citizens whose employers do not pay for their Medicare coverage and are sixty five years and above, and aliens who reside permanently in the United States and prior to their applications have lived in the United States for five years and above qualify for Medicare (Deshmukh, 2011). This is referred to as voluntary enrollment.  

Many people who are disabled do not qualify for Medicare because they do not have what is required to qualify for Social Security Disability Insurance (SSDI) payments (California Health Advocates, 2010). To qualify for SSDI, one has to be between 18 to 62 years and must provide evidence that he/she is unable to do any work for at least one year because of mental or physical disability or expected to die due to the disability (California Health Advocates, 2010). Once a person qualifies for SSDI payments, he/she has to wait for a period of five months before it starts, and an additional 24 months before benefiting from Medicare (Health Care Financing Administration, 1995). But those who receive SSDI payments because of Amyotrophic Lateral Sclerosis, start receiving their Medicare benefits in the first month they receive their payments.

Those under the age of 65 years who either have End Stage Renal Disease or have been receiving Social Security Disability Income (SSDI) payments for a period of two years, do not have all their medical costs covered with Medicare.  The uncovered areas include drug prescriptions, copayments and premiums which can be covered only when there are arrangements for additional insurance. The additional insurance can be received from private medical insurance plans (Extend Health, 2011).

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Medicare coverage for the disabled and those with permanent kidney failure that requires regular course of dialysis or kidney transplant ends when their health improves or when their kidney transplants are successful and do not develop other health conditions. Social Security monitors health status of those receiving SSDI payments to know their health status (United States Social Security Administration, 1967).

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