MaryannMcMahon_Week4Assignment1_HealthInsurance_HIM143100V

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School

Lord Fairfax Community College *

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Course

143

Subject

Medicine

Date

Oct 30, 2023

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docx

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Uploaded by MateEchidnaPerson1936

Maryann McMahon HIM 143 100V Week 4 Assignment 1 Different Types of Health Insurance 1. Medicare 1. Who does Medicare cover? 2. Who Pays for Medicare? 3. What are Medicare Parts A, B, C, and D? Medicare covers Americans 65 and older who have worked and paid, or their spouse has, through payroll taxes for at least ten years. It also provides insurance for younger people with end-stage renal disease, amyotrophic lateral sclerosis (ALS), and some with disability status that the Social Security Administration determines eligibility. Payroll tax premiums, surtaxes from beneficiaries, and general revenue provide the funding for Medicare. Medicare taxes are taken automatically from paychecks or paid as part of self-employment taxes. Medicare consists of four parts:  Part A is hospital insurance, a premium-free coverage if Medicare taxes were paid while working or a spouse was working. Those not eligible for premium-free coverage may be able to buy Part A. If the beneficiary purchases Part A, they must also purchase Part B, and monthly premiums are payable for both. Part A covers: o Inpatient hospital care o Skilled nursing facility care o Home health care o Inpatient nursing home care that is not custodial or long-term o Inpatient care in religious nonmedical health care facilities o Hospice care o Home health care  Part B is medical insurance providing outpatient medical coverage that includes monthly premiums. The monthly premiums for Part B can be high depending on the person's income bracket. Part B covers two types of services: o Medically necessary supplies or services are essential to diagnose or treat medical cases that meet accepted standards of medical practice. o Preventive services to prevent illnesses (i.e., vaccinations) or detect an illness early when treatment is most likely to work best. Most preventive services are free if the

provider accepts assignment . i o Part B coverage :  Doctor's services  Outpatient care  Home health services  Durable medical equipment  Clinical research  Ambulance Services  Mental health inpatient, outpatient, and partial hospitalization  Limited outpatient prescription drugs  Other medical services, including several preventive care. o Some of the items and services that Medicare Part A and Part B do not cover:  Long-term care (a.k.a. custodial care)  Most dental care  Eye exams (for prescription glasses)  Dentures  Cosmetic surgery  Massage therapy  Routine physical examinations  Hearing aids and fitting examinations

 Concierge care (a.k.a. concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)  Covered items or services from an opt-out provider (except in cases of emergency or urgent need)  Part C, Medicare Advantage Plan (MA), is a type of Medicare-approved health plan offered by a private company that contracts with Medicare.  It provides all Part A and Part B benefits (with only a few exclusions).  Offers an alternative way to receive Medicare coverage.  Medicare pays a fixed amount monthly to the company offering the MA.  Rules set by Medicare must be followed by the companies receiving payment.  Each plan can have different charges out-of-pocket costs and may have different rules about services.  In addition to Part B premiums, there may be a premium for a Medicare Advantage Plan. o Different types of Medicare Advantage Plans are:  Health Maintenance Organization (HMO)  Preferred Provider Organizations (PPO)  Private Fee-for-Service plans (PFFS)  Special Needs Plans (SNP)  Medical Savings Account plans (MSA)  HMO Point-of-Service plans (HMOPOS) o Medicare Advantage Plan coverage:  Includes most Medicare services

 Most plans cover prescription drugs  Extra coverage may be offered, such as dental, vision, hearing, and other health and wellness programs.  Part D is coverage for prescription drugs offered to everyone with Medicare through Medicare- approved private companies. o There is a monthly premium for the coverage. o Prescription Drug Coverage (Part D) can be high depending on one's income bracket. o Beneficiaries must have Parts A and B to join a Medicare Prescription Drug Plan (PDP) o Coverage is possible in two ways:  Added to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans.  Through a Medicare Advantage Plan (HMO or PPO) or another Medicare health plan (including Part A, B, and D). 2. Medigap policies 1. What are Medigap or Medicare Secondary policies? 2. Why would or should a patient have a Medigap policy? 3. Medigap policies are known as Plan A, Plan B, etc. How many different plans are there, and what makes these plans different? 4. Who pays for Medigap? Medicare Supplement Insurance (Medigap) is extra insurance bought from a private insurance company to aid in paying the share of out-of-pocket costs with Medicare. o Medicare secondary insurance is available through Medigap plans, the most popular secondary insurance for Medicare.

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