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.
(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.
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).
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
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.
COST CONTAINMENT PROPOSAL Introduction Patients with advanced chronic kidney disease have, in addition to transplantation and hospice care, two choices for renal replacement therapy: hemodialysis and peritoneal dialysis. Hospital systems typically incur the largest cost when these patients are about to initiate dialysis and right after the start of dialysis. Reasons for this include: required procedures to establish a vascular access, emergency room visits with subsequent inpatient stays for unplanned dialysis starts, emergent inpatient hemodialysis, and utilization of interventional radiology to place tunneled and untunneled dialysis catheters. Characteristics of patients that will incur the highest costs include: 1. Emergent need for dialysis 2.
• 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.
The "Obama Care" Exchanges are Online Marketplaces where low to middle income Americans can shop for regulated health insurance. HOW TO BUY INSURANCE UNDER OBAMACARE There are four types of "metal plans" (bronze, silver, gold, and platinum) available on the marketplace as well as a catastrophic plan for those under 30 and those who had their plan canceled due to the ACA. You can also use the marketplace to sign up for Medicaid and CHIP. Medicare and other health insurance programs are signed up for separately. You can still buy private insurance through a broker or direct from a provider.
Some family medicine doctors, internist and surgeons can also perform a UGE. Question 6, what types of medical facility or setting can the medical procedure be performed in? The medical procedure can be done in a doctors’ office, clinic and a hospital. Question 7, what is the recovery