Healthcare Policy : The Medicare Savings Program

The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.

Medicare part D is the prescription drug plan. Each plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different tiers on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost less than a drug in a higher tier. In some cases, if the drug is on a higher tier and the patient 's prescriber (the patient 's doctor or other health care provider who is legally allowed to write prescriptions) thinks the patient needs that drug instead of a comparable drug on a lower tier, the prescriber can ask the patients plan for an allowance to get a lower copayment. In the case of Mrs. Zwick Part D will cover the prescription drugs that she needs that are not covered by Medicare Part A and Part B unless those medications are on the unapproved list. What the patient will be responsible for paying

In the following table, describe each of your choices and explain their functions and roles within the health care field. Your responses should total at least 50–75 words for each choice.

Medicare is the federal health insurance program for people with certain disabilities, end stage renal disease, and for those who are over the age of 65. There are four different parts to Medicare, part A, part B, part C, and part D. Medicare Part A, also known as hospital insurance, covers inpatient hospital stays, care in nursing facilities, hospice care, and some in home health care. Part B is often referred to as medical insurance; it covers certain doctors’ services, outpatient care, medical supplies, and preventative care services. Medicare Part C, otherwise known as Medicare advantage plan is offered by a private

The first plan is Medicare A and it will cover any of your inpatient fees.

Medicare is a health insurance program purposely created for people over sixty five (65) years of age. However the service is open to people with certain disabilities or permanent kidney failures. The process of choosing the right Medicare involves having to weigh different plans on account of benefits of their cover. Different types of Medicare plans are important in: Inpatient hospital care, outpatient services, doctor visits, home health care, prescription drugs, and care in a skilled nursing facility among others. In addition, the program covers the cost of health care but does not cover all medical expenses including cost of long term care. If one ought to choose an original Medicare coverage, one may buy a Medicare supplement policy from a private insurance company to aid in coverage of costs that are not supported by Medicare. Most of these Medicare expenses are covered by a part of the pay role offered to workers by their employer. This paper covers different Medicare plans; A, B, C, D and their influence towards my decision on the best preferred option.

The passage of the Medicare Drug Price Negotiation Act will also inadvertently increase access to many types of medications for individuals who qualify for Medicare Part D. There is a clause within the bill that would establish rebates to be paid by pharmaceutical companies for low-income beneficiaries. These rebates, in addition to lowered costs, would considerably lessen the financial burden placed on low-income beneficiaries. This will allow more individuals greater access to expensive medications. As an example, each year, financial reasons hinder about 16% of diabetic Part D beneficiaries from filling at least one of their prescriptions (Williams, Steers, Ettner, Mangione, & Duru, 2013). This increase in access will help mitigate the occurrence of cost-related nonadherence to prescription medications, and other such consequences

Medicare, which was first enacted by Congress in 1965, is a popular, yet failing, program because of a rapidly increasing population of retirees and their increasing costs; despite program’s flaws, Medicare is difficult to change because of the political influence of the elderly, who approve of the benefits they receive from the program. Medicare provides health benefits to citizens who are eligible for social security benefits(Fiorina, Peterson, Johnson & Mayer 2009). The program is embraced by the public, but Medicare’s increasing cost makes it difficult to sustain. Due to its popularity, the program is also very difficult to change, but without limitations the program will continue to decline in the future.

Person eligible for Medicare include individuals ages sixty-five and over, those with disabilities, and those with end-stage renal disease (Hammaker, 2011). here are three basic entitlement categories: persons 65 years of age or over who are eligible for retirement under Social Security or the railroad retirement system, persons under 65 years of age who have been entitled for at least 2 years to disability benefits under Social Security or the railroad retirement system, and persons with ESRD who do not otherwise meet the age or disability requirements. The latter two groups together are known as the "under 65" enrollees (Petrie, 1992).

There are approximately 9 million dual eligibles based on CMS data. People who are dual eligibles suffer from multiple chronic and complex medical issues compared to those who are Medicare only. They are more likely to have severe mental disorders, be disabled, and live in an institution and have poor health status. Dual eligibles are also noted to be of low socio-economic status, with more than half earning less than $10,000 annually. The 2016 MedPAC reports showed that 59% of dual eligibles are 65years or older and the rest are less than 65 and disabled. The report also showed that 20% of the Medicare and 14% of Medicaid beneficiaries are dual eligibles. This group utilized 35% ($114.1 billions) of all Medicare and 33% ($180.2 billions) of all Medicaid expenditure for the 2011 calendar

with Medicare premiums or cost sharing. Medicare Savings Program (MSP) are of the following categories: Qualified Medicare Beneficiary– Helps pay for Part A and/or Part B premiums, deductibles, coinsurance, and copayments; Specified Low-Income Medicare Beneficiary – Helps pay for Part B premiums; Qualifying Individual (QI) – Helps pay for Part B premiums;

Part A covers the hospital portion and Part B covers the medical portion. If you qualify and have at least one part then you are eligible for Part D coverage as well. Part D helps people on Medicare to be able to cover some of their prescription costs. This is not a free coverage but requires a monthly premium. All prescriptions are based on a formulary where a low tier will cost the patient less versus a high tier costing more. The idea is that low tier medications will be

Describe differences between Medicare part A and Medicare part B when it comes to group and concurrent treatments?

Medicare part A benefits apply as soon as the patient is admitted to the hospital and end when the patient is hospitalized for 60 consecutive days. After 60 days, the patient will be responsible for copay from 60 days to 90 days. Medicare part A pays for hospital and skilled nursing facilities only when deemed medically necessary. Initial copayment is required upon hospital admittance and separate copayment is required after 60 days within a benefit period. Once the patient pays the copay, the hospital or skilled nurse facility will document all services provided to patient. Coding will assign payment codes to all services rendered for billing purposes. Once all codes are in place and assigned to a service provided, all services will be reviewed and a claim will be filed. A claim cannot be filled until the patient is discharged. A patient can stay a maximum of 100 within a benefit period as long as the patient continues to pay copay after 60 days. Medicare part A only covers inpatient hospital and skilled nursing facilities. Medicare part A does not cover Outpatient services. Medicare part B covers Outpatient services or supplemental services. Physician and surgeon services such as dentists and podiatrist services are reimbursed under Medicare part B coverage. Medicare part B coverage must be documented as medically necessary or medically preventative in order to be covered and reimbursed. Medicare part B usually carries a deductible and only covers outpatient services that

The major purpose of this work is to completely discuss about the Medicare Part D which will set an influence on the different interest groups and all the entities of government which have been set under the policy changing process. There has been a complete set environment which involved and shape the policy to make efforts as to how all the groups of the stakeholders are influences with the Medical Part D. All the legislation and the specific strategies are made in correspondence to the politics. (Powell et al., 2015). The Medicare Part D is also said to be Medicare prescription drug benefit which directs to setting the United States Federal government programs to work on the subsidizing costs of all the drugs of prescription which insure premiums for the Medicare in US. There is a great enactment which has been based on Medicare Modernization Act of 2003. In December 2003, there are major Medicare Prescriptions which have become into the Improvement and Modernisation Act to become a proper law. There has been a great benefit from the drugs which provides an entire coverage to all the disables and the elderly people who could not have the ability to manage it.