Medicare And Private Insurance Case Study

Understanding your Medicare coverage can be a bit of a hassle. But it's important that you do understand your coverage, because it has a lot to do with your financial security. You should be aware of what you have covered in terms of medical expenses in terms of in patient, out patient, doctor's visits, and medications. That way you'll know what to expect if you use a lot of medications or end up going to the doctor, and you'll be able to arrange your finances accordingly.

Medicaid and Medicare was created and called the Social Security Act of 1965 to provide coverage for medical treatment for qualified individuals and their families. Medicaid is a program that is jointly funded and managed by the federal and state governments that reimburse hospital and physician for providing care to qualified patients who cannot afford medical expense. To qualify for Medicaid he or she must be a United States or resident citizen which, includes low income adults and their children, people with certain disabilities and senior citizens. “Medicaid and Medicare is overlooked by the Center for Medicare and Medicaid,

Medicare is the nation’s largest health insurance program. Generally, you are eligible for Medicare if you or your spouse worked for at least ten years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. Medicare-covered services include hospital insurance, inpatient hospital care, skilled nursing facility care, home health care, hospice care, and medical insurance (Medicare U.S.) With such an encompassing effect on the health insurance field, Medicare provides a haven for older individuals, and end-stage renal disease (ESRD) patients who require the best medical care for whatever possible reason. The only problem with this scenario is

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).

Health service system as defined by "Roemer" in the text is the pooling of resources, organizations, financing, and management that aggregates to the delivery of health services to the needs of a population (Barton, 2010, p. 3).

With the Advent of the Affordable Care Act, came many changes throughout the medical industry, changes happened in hospitals, health insurance, and doctors. Doctors, more than any other group seem to be affected in a number of way, from the amount of patients, from the increased number of people with insurance plans. It also changed the way a doctor interacts with other parts of medicine. There are some questions arising from this such as; would doctors approve or disapprove of these changes along with do these changes affect the doctors' ability to practice. For the most part, there is no difference the way doctors practice or to their income, but it does have doctors utilize their abilities towards medicine rather paper pushing which could have doctors prefer the post-ACA medical community rather than before.

Medicare is a federal health insurance program. This program pays for a variety of health care expenses for people who are 65 and older, adults with approved medical conditions such as Lou Gehrig’s disease, qualifying permanent disabilities may be eligible. It is financed by payroll taxes, premiums paid by voluntarily beneficiaries, income taxes paid on Social Security benefits and interest earned on the trust fund investments.

think that Medicare is one of the greatest and most important programs for US society that was ever created. Followed by National Defense and Social Security program, Medicare is the third largest program in the Federal budget. In 2013 cost of Medicare was $492 billion which is 14 percent of total federal spending. According official information by the end of 2014 49,435,610 people received health coverage through Medicare program.

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

Medicare is a valuable part of health insurance in the United States. Although it is a popular program, it will face a number of financial issues and challenges in the future.

Medicare is another section that will feel some relieve from practices brought from the Act. As mentioned before, the cost of health care is expensive, therefore making it difficult for those under the Medicare plan to seek preventive services. Before moving forward on the effects of the Act on Medicare, one must first explain some of the benefits of Medicare. Medicare is the nation’s largest health insurance program, it serves more than forty-two million enrollees, and it was originally established to provide access to health services for the elderly (Carroll, 2009). One can grasp the idea that the nation, along with its government, has made constant efforts to support the health of all Americans. This especially true for the ever growing

“I’m so sorry Mrs. Jones, but your insurance doesn’t cover that.” My mother stood, staring in disbelief at the $850 invoice that she received for her C-Pap machine. She had no clue how she was going to pay for it since her only income is her monthly social security disability disbursement, which is only $850. She desperately needed this machine for her Sleep Apnea but how would she afford this when she has so many other expenses? Why isn’t Medicare covering the cost of this machine? They covered the hospital stay that led to the diagnosis, so why not this? This scenario and similar ones present themselves far too frequently. As a solution, let’s discuss the basics.

Medicare part A is Hospital Insurance. This means that it covers the costs associated with a hospital visit, such as a room and food (https://www.medicare.gov). Medicare part A is funded by a 2.9% tax split evenly between workers and employers.

Majority of individuals with Medicare get their health coverage from Original Medicare and Medicare Advantage Plan. However, compared to Medicare Original, Medicare Advantage covers all the services under Original Medicare barring hospice care. According to Medicarerights.org, Medicare Advantage Plan must cover same Part A and B Original Medicare benefits, in addition to extra benefits such as dental care and vision in some cases. The plan comes with an out of pocket yearly limit, after which you are expected to pay nothing for the rest of the year.

Understanding the classification of healthcare services in terms of acute and long term care enable us to plan for services, to describe institutions, and to allocate funding and reimbursement. In the United States, healthcare services provided by health care providers (such as doctors and hospitals) are paid for by the following including, private insurance, Government insurance programs, people themselves (personal, out-of-pocket funds). Additionally, the government directly provides some health care in government hospitals and clinics staffed by government employees. Examples are the Veteran’s Health Administration and the Indian Health Service.