Medicare Part A Case Study

A part of the problem of cost was the establishment of “free” healthcare for those eligible for Medicare and Medicaid, between 1965 and 1971 where there was no limitation on benefits. The cost of healthcare increased from 39 billion in 1965 to 75 billion in 1971. Providers had no concern for the cost of their care seeing that SSA recipients had no limits

Part A covers hospitalization, emergency hospitalization, subacute care, home health, and end of life care depending on the situation. Part B covers Doctors’ visits, and covers subacute, end of life, and in home care that Part A will not cover if the patient qualifies. While part C covers medications and needed medical equipment (Center for Medicare and Medicaid Services, 2014). What Medicaid pays for depends on what state you live in, and what your specific situation is. Universally Medicaid covers hospitalization, day procedures, doctors’ visits, nursing facilities, home care, child health check, nurse practitioners, and transportation to doctors’ visits (Medicaid.gov, n.d). Medicaid offers different services in each state, but the aforementioned are the mandatory areas of coverage for every state. Medicare is aimed at helping the older population, while Medicaid is aimed at people in every stage of life. But who exactly is covered under which

“Medicaid covers basic health care costs such as visits to the doctor and hospital stays, but can also cover things like the costs of eyeglasses… Medicare covers hospital and post-hospital facility charges, as well as home health care, doctor fees and lab costs, outpatient care, and prescription drugs” (Reuters). Medicaid covers simple costs, meanwhile Medicare pays for more expensive cost such as doctor bills. With Medicare there are four different parts: Part A, B, C, and D; however, each part has different coverages. Medicaid may charge patients small service fees and with Medicare there is a yearly deductible for all plans; with these different plans they copay lengthy time in the hospital which would be Part A, Part B covers 20 to 35% of medical bills, plus monthly premiums, and Part D has coverage gaps that will not cover total drug costs over $2,840, but will once total drug costs reach $4,550 (Reuters). Medicaid patients usually pay nothing, but a small co-payment is sometimes required. With Medicare, Medicaid will often pay for what Medicare will not pay for. For example, deductibles, premiums, and sometimes up to 20% off medical costs. For Medicare, payment charges may vary depending on what plan the patient has. With saying this, what services they cover and the cost are a big impact on which insurance the user would most

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.

Fifty years ago, Lyndon B. Johnson signed the Medicare program into law. “It has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses.” (Hamel, Blumenthal, Davis, & Guterman, 2015, p. 479). With the encouragement of George W. Bush, congress passed the Medicare Modernization Act of 2003 (MMA). The MMA extended Medicare to include prescription-drug coverage, known as Medicare Part D. In 2013, Medicare covered the health care expenses for 52.3 million Americans, costing $583 billon. Originally, Medicare had difficulty controlling costs; physicians and hospitals were

Medicare, as nationwide social insurance passed into law as title XVII of the Social Security Act of 1965, currently using about 40 private insurance companies across the United States. The primarily purpose of Medicare was to provide financial support to elderly age sixty-five and older or younger people with a permanent disabilities. There are four different parts of Medicare plans to select from: “Part A provides hospital and skilled nursing coverage’s through Hospital Insurance Trust Funds. Part B covers physician services, ambulatory surgical services, and other miscellaneous services paid by Medicare beneficiaries. Part C is managed care coverage offered by private insurance companies. It can be selected in lieu of Part A and B). Medicare Part D covers

The majority of Medicare issues result from structural complexity and fragmentation, resulting in confusion for beneficiaries and health care providers alike. Most insured nonelderly Americans enroll in single health plans that pay for all covered services, including inpatient, physician, pharmaceutical, and rehabilitation, with a single system of premiums, copays and deductibles (Blumenthal et al. 486). In contrast, Medicare beneficiaries must deal with a variety of different plans to cover these same expenses, each

Parts A and B are apart of the “Original Medicare”. Meaning care that is managed by the federal government. Part A of Medicare is hospital insurance. This covers hospital care such as inpatient care, hospice care, home health care services, and nursing care facilities. Generally free of charge if the beneficiary has worked and paid Medicare taxes for at least 10 years. If not a monthly premium is established. Typically, part A doesn’t cover the whole hospital bill. For at least 60 days Medicare will pay for 100% of the hospital stay charges or 100% of 20 days at a skilled nursing facility, and after that a flat rate amount is paid up to the maximum number of covered days.

Medicare also does not pay for long-term care services, routine dental care and dentures, routine vision care or eyeglasses, or hearing exams and hearing aids. The deductibles are extremely high for the enrollee and their beneficiaries and there is not a limit on the annual out-of-pocket expenses that one could accrue. (Carroll L. Estes, 2013)

Medicare offers health insurance to individuals over the age of 65, people with certain disabilities, persons with Lou Gehrig’s disease, and individuals with severe kidney disease. Benefits are available regardless of an individual’s income. Medicare is administered exclusively by the federal government. Medicare stipulates one must be a U.S. citizen or legal resident for five years; and that he or she has contributed to FICA payroll tax for a minimum of 10 years. Medicare has a number of parts (A, B, C, and D); that pay for specific types of health care costs. Following a three day stay in a hospital for skilled care, nursing home care is covered only for 100 days by Medicare. Copays and deductibles (sometimes quite substantial) are paid by beneficiaries of this program.

Medicare is broken down into different parts that those who are insured can choose what program is best for them. There are four different parts to the Medicare health care system. There is the Medicare Part A, this part covers hospital insurance, meaning stays in the hospital, care

Medicare is one of the major financing sources for healthcare since 1965. Hospital Insurance or Medicare Part A is funded 1.45% from employee payroll tax and 1.45% from employer on all revenue. Self-employed individuals pay 2.9% of income. The government support nearly 75% of Medicare Part B and the other 25% is paid by individual’s monthly premiums. Medicare Part B individuals will be covered 100% once their $147 deductible is met. (Shi, L., & Singh, D. A., 2015)

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

Even though the United States is one of the wealthiest countries in the world and it spends far more per person on health care than any other nation, its people are not the healthiest. The U.S. spends over $2.5 trillion per year on health care (Cummings, 2015). Currently, the US government funds two types of health plans: Medicare and Medicaid. These are intended to help the elderly, disabled, poor, and young. These programs help those who are unable to pay for health insurance and cover expenses that may not be covered by their own insurance. The disadvantage of having Medicare or Medicaid is that not all doctors accept this insurance and it has been linked with receiving substandard care by those caregivers who do accept them. The basic Medicare policy is often not enough coverage as it only covers about 64% of a person’s health care costs (“What is the Difference Between Medicare and Medicaid?,”2016) . It does not cover deductibles, co-pays, and additional insurance (“What is the Difference Between Medicare and Medicaid?,” 2016). In 2014, the ACA was implemented. This lowered the number of people who did not have health insurance. Under the ACA, individuals can shop for new health insurance plans on exchanges, or health insurance marketplaces, so as to find the best plan for them both financially and one that meets their overall health needs (Cummings, 2015).

The last part of Medicare includes a prescription drug plan, known as Part D.  Part D adds prescription drug coverage to original Medicare, some Medicare Cost Plans and Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.  Insurance companies offer these plans and other private companies approved by Medicare.  Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans (Medicare, 2013).