Introduction
The concept of Medicare indicates the support the US government provides to people above the age of 65, younger people who have certain disabilities, and people who suffer from End-Stage Renal Disease. There are four services that are offered via the Medicare program of the government. Medicare Part A is also known as hospital insurance. Part A of the Medicare program caters for the concerned individual’s hospital stays along with adequate nursing facility, and health care facilities at the patient’s residence. Medicare Part B is the medical insurance that the patient gets. As a result of medical insurance, the services of certain doctors are provided to the patient along with outpatient care, medical supplies, and preventive services. The Medicare Advantage Plans also known as Medicare Part C may be considered as an outsourced service of the Medicare health plan. In Medicare Part C, a private company works in coalition with Medicare to provide the benefits offered in Part A and B. The most distinctive feature of Part C is that it offers the prescription of drugs. Similar to Part C in certain ways the Medicare Part D is also concerned with prescription drug coverage. However, prescription drug coverage is added to the original Medicare program in this part. Insurance companies and other Medicare approved private companies have mostly included Part D in their programs (Medicare.gov).
Nursing Homes
At times certain individual’s need 24-hour care which may not be possible while living in their own home; therefore, for this reason nursing homes are blooming as a business. Nursing homes may not be limited to older people; however, anyone who needs attention throughout the day would require this service. There are several types of nursing homes. Some nursing homes have a homely environment where people do not have any restrictions and are very similar to their everyday lives outside the home. On the other hand, some nursing homes follow a hospital pattern with nursing stations on every floor and there is a schedule that is followed by people admitted there. Certain types of diseases such as Alzheimer’s may require more restricted nursing facility with constant supervision. Adding on, in certain institutions couples are allowed to live together and lead a normal life but with a special external care provided (eHealth).
Medicare and Nursing
Nursing homes under the Medicare program may only be offered to individuals who satisfy certain criteria. The individual must have enrolment in Medicare Part A and should have days of nursing home coverage pending out of the 100 days of nursing care within a benefit period. The individual would qualify for admittance in a nursing home of he/she has an inpatient stay of at least 3 consecutive days at the hospital. One important criterion is that the nursing home selected by the individual should be approved by the Medicare plan. Moreover, the care provided should be within 30 days after getting discharged from the hospital. Most importantly, the individual’s doctor should prescribe the need for nursing home. If an individual requires constant care from a skilled professional then he/she may qualify as an adequate member for nursing home facility. At times, the patient may not require the attention given in hospitals, but may require attention greater than that received at home by a specialized personnel; therefore, the nursing home may prove as the best alternative of a hospital in certain circumstances.
There are certain services of nursing homes that are provided to members of the Medicare program. Semi-private rooms, meals, skilled nursing facility, physical and occupational therapy, medical social services, medications, medical supplies, ambulance transportation, and dietary counseling are some of the services that are available to Medicare members within a nursing home (eHealth).
Medicare Part A
Part A of the Medicare program helps pay for inpatient hospital care, skilled nursing facility care, home healthcare, and hospice care. In the inpatient hospital care, the patient can avail this service for 90 days of every benefit period. The most distinctive feature of the inpatient hospital care is that it covers 190 lifetime days in a psychiatric hospital. Part A also helps pay for a skilled nursing facility for 100 days in a benefit period. The patient should be admitted in the hospital for 3 consecutive days, and the doctor must prescribe specialty care in order for the patient to avail this service. 100 days of home healthcare are also paid for by the Medicare Part A. The individual should be admitted in the hospital for 3 consecutive days and must avail this service within 14 days of getting discharged from the hospital. Hospice care is provided to the individual on the discretion of the doctor and is not restricted in the number of days; however, the life expectancy should be six months of the individual who qualifies for this program (MedicareInteractive).
If, for instance, an individual is admitted in the hospital for 100 days to treat a broken hip and is discharged from the hospital after the 100 days are over. If after 20 days the other hip is also broken then the individual must take into consideration certain technicalities. The first 20 days are covered fully by Medicare and days 21 to 100 are covered by Medicare once the individual pays $152 per day as reported in 2014. As the individual broke her hip before the 60 day resting, period was over she does not qualify for a new benefit period. In other words, the individual is not able to benefit from Medicare Part A anymore because she has already utilized her 100 days. To ease the financial burden of hospital care cost Medicare has a subsidiary by the name of Medicaid. The affected individual may contact Medicaid if he/she is unable to pay his/her medical bills. Upon scrutiny of the individual, and their financial background, Medicaid may make the decision of giving assistance or not (MedicareInteractive).
Medicare Part B
The Part A of Medicare is concerned with the contingent aspect of an individual’s life and mostly covers those services that may be required under emergency situations. Part B may not be applicable for the majority of the people as it is not a fully covered plan. The services covered by Medicare Part B include; Hospital, doctors, and home healthcare, preventive shots, and screening labs and tests. In Medicare Part A, the individual does not have the facility to provide tests and lab fees; however, this is essential before anyone is formally diagnosed with an illness or before the start of treatment. Individuals who require extensive coverage of services they should opt for Medicare Part B. Adding on, Medicare Part B includes; mammograms, dialysis, limited prescription drugs, and physical therapy. If an individual who has Medicare Part B may receive home care from a skilled professional on a part-time basis. One of the most basic features of Medicare Part B is the inclusion of one pair of spectacles. Therefore, if an individual loses his eyeglasses he/she may get a new pair under Medicare Plan B (Zacharczyk, 2013).
If an individual has insurance coverage from his/her employer then they may consider enrolling in Medicare Part B. If an individual requires care of specialized nursing facility then after considering the services required they should decide which Medicare program to enroll. However, this may best be understood by discussing with the doctors and the specialized nursing facility itself. If an insurance plan covers certain costs then Medicare Part B may be helpful to the individual considering enrollment in the program.
Medicare Part C
Medicare Part C is different from Part A and B because it gives the member to make the changes as he requires. In other words, it may suggest that Medicare Part C is a flexible program as it includes elements of both Medicare Part A and B. The individual may also have the freedom to choose the services that he/she wants added in their plan (CNN Money). Because Medicare Part C is run by private companies these companies focus towards making profits; thus, providing the customers with what they need rather than having a fixed set of choices. However, even though Medicare Part C gives the individual a greater coverage, but the individual may only be treated under his Medicare plan if they visit certain doctors and hospitals. The cost of the plan may also be in the control of the member as he/she may determine what services they want; thus, depending upon the individual’s affordability the Medicare Part C may be designed.
Medicare Part D
Medicare Part D or Medicare drug benefit is an ideal plan for those individuals who are on a limited income and have to manage their budget, but are concerned about their future. Similar to Medicare Part C this Part D is available only through private companies and anyone who has Medicare qualifies to enroll for Medicare Part D; however, an individual must be enrolled in a private drug plan before enrolling in Medicare Part D. The individual’s financial circumstances would determine whether they should enroll in the plan or not. Those individuals who are already enrolled in plans on low-income assistance automatically become get enrolled in Medicare drug plan which provides them with financial health (California Health Advocates).
Conclusion
The Medicare plans are for special individuals in society and provide benefits relevant to their needs. One of the biggest advantages of having a Medicare plan is that the individual does not have to stress about certain things if he/she falls sick. Every plan covers different costs and the individual may select which plan best suits his/her needs. As the Medicare plan does not differentiate between rich and poor; therefore, a greater number of people may benefit from this facility. Moreover, nursing facilities are specifically covered by Medicare as this is an unusual option for insurance companies to cover. As the need for nursing homes is increasing Medicare keeps this concern into consideration while planning their various services.
References
Medicare Interactive. (n.d.). Medicare Interactive. Retrieved May 31, 2014, from http://www.medicareinteractive.org/page2.php?topic=counselor&page=case_study&casestudy_id=18
Prescription Drug Coverage: An Overview. (n.d.). Prescription Drug Coverage (Medicare Part D): An Overview. Retrieved June 1, 2014, from http://www.cahealthadvocates.org/drugs/overview.html
What is Medicare Part C?. (n.d.). CNNMoney. Retrieved June 1, 2014, from http://money.cnn.com/retirement/guide/insurance_health.moneymag/index16.htm
What is Medicare?. (n.d.). Medicare.gov: the official U.S. government site for Medicare. Retrieved May 30, 2014, from http://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html
Zacharczyk, R. P. (n.d.). What Is Medicare Part B?. - For Dummies. Retrieved June 1, 2014, from http://www.dummies.com/how-to/content/what-is-medicare-part-b.html
eHealth. (n.d.). Medicare and Nursing Homes. Retrieved May 31, 2014, from http://www.ehealthmedicare.com/about-medicare/nursing-homes/
