This part carries a deductible and a monthly premium. Part B is also voluntary enrollment. • Part C – also known as Medicare Advantage Plans work with HMO and PPO to provide a custom plan for patients to receive accurate care with specific needs. • Part D – requires a premium and a deductible. This part works with private insurance companies.
The author will discuss the differences in Parts A, B, and D. Medicare Coverage Part A Medicare Part A is often called the hospital insurance because the coverage is primarily directed at hospital services. Part A covers inpatient care in a hospital, skilled nursing facility (SNF) and “Religious Nonmedical Health Care Institutions” ("Medicare Handbook," 2012, p. 27). In addition to this, Part A covers Home Health and Hospice care. This coverage includes all meals, a semi private room, medications administered during the inpatient stay and general nursing. The deductible that must be paid by the patient in 2013 is $1184.00.
Part A is the hospital insurance which helps pay for the in-patient care at a hospital or skilled nursing facility following a hospital stay, some in- home health care and hospice care. Part B is the medical insurance that helps pay for doctor visits and several other medical services and supplies that are not included by the hospital insurance. Part C also known as Medicare Advantage plan is like HMOs or PPOs and is offered by private companies approved by Medicare. The Medicare Advantage Plan provides all of Part A the hospital insurance, all of Part B medical insurance and may offer some extra coverage, such as vision, hearing, dental, and/or health and wellness programs as some include Medicare Part D, which is the prescription drug coverage. Part D is the prescription drug coverage that helps pay for doctor prescribed medications for treatment (Medicare, 2012).
In this journal, I will be reflecting about how insurance companies, hospitals, and patients can use Cost-benefit analysis for sustaining a life. First and foremost, Insurance companies routinely use cost-benefit analysis in healthcare to set policies and decide whether to approve claims. Many companies have blanket policies on general treatments, to either approve or deny them. If the cost is unacceptably high and the benefit is marginal or low, the company may deny treatment. In the event of an appeal, it can perform a more rigorous analysis of the situation.
* Identify key macroeconomic variables that affect your industry. * Consumption- in today’s society the health care industry provides health care services to individuals by * Output- * Unemployment/ uninsured- * The health care industry is affected by individuals not being covered by insurance. This results in people who really needing health care services and not being able to pay for them. If individuals are laid off or not working they may not have the disposable income to pay for treatment, medicines or other services provided. Health insurance plans pay doctors, hospitals and other providers in various ways such as fee for service, bundled payments or a fixed amount for all services that a patient may receive over a period of time.
Amanda Huff 3/1/2012 Ramifications of Participation Contracts Providers must evaluate health plan, like employers and employees. Most providers have several contracts with health plans in their area. A medical insurance specialist may be asked to assist with considering participating contracts with health plans. The major question is whether participation in a plan is a good financial opportunity. Participation contracts resent opportunities for providers by attracting new patients to their practice.
Certification affords hospitals to participate in federally funded Medicare and Medicaid programs. Accreditation is defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve.” (Raik, 2001) Continuous improvement should be the ultimate goal when providing health care to the public whether it is a private for profit organizations or a community health center that is not for profit. There are both national and international accreditation bodies that survey and provide hospitals with accreditation. In the United States the standard for hospital accreditation is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which per
How can an acceptable quality of healthcare be assured for all? Somia O’Kelley HCA 305 The U.S. Health Care System Professor Shannon Corbett-Perez June 13, 2011 How can an acceptable quality of healthcare be assured for all? Quality Healthcare can be achieved by providing patients with a comprehensive range of services that will ensure adequate and efficient quality care. Since the needs of patients differ from one to another, we must find a system that is beneficial to everyone. When ensuring that every patient receives quality care there are several things we must consider such as healthcare costs, medical technology, and most of all the credentials of physicians chosen to render services to patients.
Features of Health Plans Major Types of Health Plans Indemnity plan, health maintenance organization, point-of-service, preferred provider organization, and consumer-driven health plans are the five major types of health plans. All of these health plans have similarities and differences, but some are better for consumers and the others are better for providers. The indemnity plan indemnifies the policyholder against the cost of medical service and procedures as listed on a benefits schedule, but the patients can choose the provider that they want to see. Health maintenance organization (HMO) has their own network of physicians, hospitals, and other providers by negotiating contracts with them. Consumers who have HMO pay a premium for coverage on medical cost and delivery of health care.
Its Primary purpose is to ensure quality patient care and managing the cost of that care. Its secondary purpose as defined by the Institute of Medicine (IOM) deals with individual users for education, regulations, policies and public health from data entered, verified, corrected or analyzed directly or indirectly. Homeland Security has recently been added to the list of users, including patient care providers, managers and staff, coders and patients themselves. Patients can make changes as necessary. Other users might include lawyers, employers, law enforcement and researchers.