Medicare is a Federal Government program designed to cover people age 65 or older, people with certain disabilities and serious kidney failure. Within this program, there are four sub divisions also called “parts”. • Part A - cover hospital insurance such as hospital stays, nursing facilities, supplies, etc. • Part B – cover Supplementary Medical Insurance such as physician and nursing services, home – health services, outpatient visits. This part carries a deductible and a monthly premium.
Healthcare Financing Medicare was created in 1965 as a way to provide affordable health care to qualified United States residents age 65 and older. In addition to the age criteria, a person can quality for Medicare if they are disabled and receiving Social Security benefits for at least two years or have End Stage Renal Disease. Since the majority of the costs are paid by the working citizens in the form of payroll taxes called Federal Insurance Contributions Act, the insured is not responsible for the premium costs. Part A and B were two parts of Medicare originally but now the program has expanded to four parts. 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.
The Medicare program is for an individual who is at least 65 years old, under 65 and disabled, or any age with permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). It also requires that the person is a U.S. citizen or has been a legal resident for five continuous years and has paid into Social Security for at least ten years and is eligible for the benefits. Medicare helps those people with the cost of health care, but it does not pay for all medical expenses or the cost of most long-term care. There are four parts to the Medicare program. 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.
The Transition Plan is an HMO product including a prescription drug benefit that helps reduce monthly premiums (Kaiser Permanente, 2011). Having a community partner helps Kaiser Permanente to identify low-income individuals in which are not eligible for Medicaid and Medicare. The community partner helps individuals apply to the Transition Plan. In addition, the Ohio Region has an Access to Care Program called Healthy Connections Network in Akron, which assist individuals that are ineligible for other assistance programs. Many patients in which has a medical home are more likely have better continuity of care and less likely to need high-cost emergency care services (Kaiser Permanente, 2011).
According to Shi & Singh (2012), reports showed that 1 in 3 or 87.6 million Americans were uninsured between 2008 and 2009 under the age of 65. This has contributed to the raise in health care costs. In order to reduce costs, the U.S. health care delivery system needs to have a plan in place to ensure that all of America’s population is insured such as the creation of the Obama Care Plan. The term delivery refers to the provision of health care services by various providers (Shi & Singh, 2012). Providers include physicians, hospitals, clinics, private doctor offices, and other entities.
(0.5 points) Health insurance helps pays for your medical bills and expenses. 5. What is COBRA? (0.5 points) COBRA is a federal government act that allows employees who lose their health benefits the right to continue participating in the insurance plan for a specific amount of time. 6.
There are many benefits and services provided by the Department veterans are entitled to. One is disability compensation is a monetary benefit paid to veterans physical and/or psychological injuries incurred while in the injuries may vary amongst individuals, each case is handle monthly amounts of compensation vary due to the percentage rate a disability rating. The Department of Veterans Affairs offers health care service no charge. Stipulations such as service connected disability may warrant free medical coverage. Veterans attending school at least 3/4 time and collecting vocational rehabilitation/ch.
Having problems paying for primary healthcare is no longer the preserve of the poor or the unemployed, but is affecting even those with medical insurance (Shea, 2005). Fifty million Americans lack medical insurance, while another twenty five
• Overview of the different Medicare and Medicaid services Medicare covers the services such as lab tests, surgeries, and doctor visits (CMS.gov). Supplies such as wheelchairs and walkers that are considered medically necessary are also covered (CMS.gov). Other services covered are the following: Hospital Care Skilled Nursing Facility Care Nursing home care (as long as custodial care isn’t the only care needed) Hospice Home health services (CMS.gov) Medicare health plans cover: • Medicare Cost Plans • Demonstrations/Pilot Programs • Programs of All-inclusive Care for the Elderly (PACE) • Medication Therapy Management (CMS.gov) Medicare coverage is based on 3 main factors (CMS.gov): 1. Federal and state laws (CMS.gov). 2.
Other users might include lawyers, employers, law enforcement and researchers. Government licensing agencies make policies that have been determined from the analysis of aggregate data gathered from medical records, in federal and state databases. Institutional users such as hospitals or clinics, depend on the Data Quality Management Model for adequacy and appropriateness of care determined by medical review organizations and the effectiveness of healthcare services reimbursement guidelines enabling the coding and billing departments to receive payments for their services. Research organizations use data to aid in experimental patient care and keep