Essay on Issues with Financin Medicare

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.

Medicare part A is referred to hospital insurance and part B is medical insurance. What part A Medicare does is it covers the inpatient in hospital care. This Medicare is available to the people who have worked about ten years and also paid their Medicare taxes while working. The benefits part A Medicare has is they do not have to pay monthly premium to receive care. Part A Medicare does not cover for everything you will have to pay half of it. With this you also have to pay the deductible fees and then Medicare will cover for the rest you have left to pay off. Medicare part B covers some of the non-hospital expenses. In this insurance you have to also pay the monthly premium and if you have a high income the fee will be more.

In 1965, President Johnson signed Title XIX of the Social Security Amendments, which enacted Medicare and Medicaid (CMS, n.d.). Originally, Medicare was composed of Part A and Part B. Part A is covers more medical costs associated with hospital stays, while Part B cover medical costs such as durable medical equipment, nebulizers, some vaccinations (Pneumovax ®, Zostavax ®, and Flu), and some nebulized breathing treatments. The original program was designed to cover disabled individuals and every over the age of 65.

Medicare Part A and B are known to be part of the original plan established in 1965 (AARP, n.d.). In addition to this plans, Medicare part C is offered by private insurance companies and is known as Medicare Advantage Plans (AARP, n.d.). Medicare was expanded to add benefits to Medicare recipients. With this expansion

Part C also has drug coverage, alone with other disadvantages it is HMO. Patients are limited to doctors and healthcare providers only unless it’s an emergency. Medigap requires members to have Medicare Part A and B to enroll. Medigap only covers the insured, not their spouse, a separate policy will have to be purchased for the spouse.

When it comes to varies insurance companies such as Medicaid and Medicare insurance company pays very differently. Medicaid will pay for the patient medical billing and patient who has Medicare depending what they have if it’s Medicare plan A or B. There are very different and Medicare A will only covers inpatient care at a hospital, skilled nursing facilities, and hospice. For Medicare B will cover doctor’s visits, and any other health care providers services, outpatient care, durable medical equipment, home healthcare, and there are other services that it may cover. So what not covered by Medicare A and B they will have to pay out of pocket unless they have any other insurance that will pay the remaining. Healthcare providers can have a

Medicare Part B is an important part of getting the right coverage. As part of Original Medicare, it provides many services and supplies that are medically needed to treat your health conditions. Some examples of covered care include

Medicare Part A is the part that covers hospital stays, nursing facilities, home health care and hospice care. This portion of Medicare is free to everyone, as long as they have paid social security taxes for ten years. If they did not pay these taxes there will be a small monthly premium charge. This part of Medicare is very important because as we get older our chances of needing health

Part B covers things for patients like diapers, or other day to day medical equipment, certain home care services, physician and outpatient hospital services. Medicare part C is also known as Medicare Advantage plans which covers things for vision, dental, hearing and/or health and wellness programs. With Medicaid it can vary from state to state and may vary in services and amounts that are given to each family size. Under Medicaid you must be categorically and medically needy and special

After reviewing the Medicare website, I learned a few new things as well as had some previous knowledge clarified. First, I learned that Medicare offers a lot more services that I initially thought such as alcohol misuse screenings, depression screenings, HIV screenings, and sexually transmitted infections screenings and counseling. In addition, prior to reviewing the website, I knew that there were two parts to Medicare, Part A and Part B, however I did not know that difference between the two parts and the different services they provide. I learned that Part A is basically hospital insurance that covers visits to a facility such as a hospital or doctor visit. Alternatively, Part B is medical insurance that covers the actual services and medical equipment such as outpatient care and preventative services.

“Original Medicare is administered directly by the way most people get their Medicare, and has two parts: part A and part B. Medicare Part A (Hospital Insurance) that covers most medically necessary hospital, skilled nursing facility, home health, and hospice care. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years), you will pay a monthly premium if you have worked and paid taxes for less time” (Medicare Interactive, 2016). “There are currently 50 million Medicare enrollees. Projections are expected to increase to 60 million by 2050” (Niles, 2015, page 215).

Part C is not a separate benefit, but it allows for private health insurance companies to provide Medicare benefits. The benefit of having a health maintenance organization (HMO) is it can cover health care services that may not be covered under parts A and B. This would include dental, hear, and vision care (“What you need to know about Parts A, B, C, and D,” 2011). Part D of Medicare includes outpatient prescription drug insurance. This can only be obtained through private insurance companies that have contracts with the government (“What you need to know about Parts A, B, C, and D,” 2011).

Some of the financing medical care I will be discussing are Medicare, Medicaid, (MediCal), US Department of Veterans Affairs, Indian Health Service, private insurance or out of elders’ pockets (Ferrini). There are four parts of Medicare. Part A is a hospital insurance, Part B is medical insurance, Part C is a private managed plan, and Part D is

Outpatient institutions such as clinics follow reimbursement processes similarly as inpatient institutions such as hospitals. If a patient receives care in an outpatient facility within his or her Managed Care Plan Network, the institution would follow similar steps for reimbursement. The outpatient institution will provide in scope medical services to the patient. All services provided to the patient will be recorded throughout the patients visit. Charges are established in accordance to DRG’s and CDM’s and appropriate codes are assigned for billing. A claim for the patients visit and services rendered can then be prepared with all necessary codes by the outpatient institution and submitted to the patients respected payer institution. Through a Medicare Advantage Prescription Plan, Medicare part C plan can include drug coverage and all benefits are included under one benefit plan. To qualify for a Medicare part D plan, Medicare part A and Medicare part B must be carried. Monthly premium for Medicare part D is also required.