Homework Assignment #5 Chap 8 Healthcare Payors and Financing
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Medicine
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Nov 24, 2024
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Question #1: You are advising your grandparents or another family member about how to get the best
benefit from their Medicare plan. In very simple terms, and in your OWN WORDS (do not just "quote"
from the textbook), describe the four parts of Medicare, and why each is important.
To maximize coverage, it is essential to comprehend how each of the four Medicare components
functions. In advising my grandparents in the benefits for the Medicare plan, they need to understand
every aspect of the Medicare plan. Firstly, there is Medicare Part A, which I would describe as hospital
insurance coverage. It covers hospitalization, skilled nursing facility care, palliative services, and a portion
of home health care. This is crucial because it ensures they will not be financially burdened if they ever
require hospitalization or specialized care after a hospital stay. Part B of Medicare is the part that covers
medical services and doctor's consultations. It includes medical visits, diagnostic procedures, and
outpatient care. Part B is vital since it assists in keeping them healthier through offering access to
preventative treatments as well as vital medical services beyond the hospital.
Then there's Medicare Part C, sometimes known as Medicare Advantage. I would explain that
this is an alternate method of receiving Medicare benefits through private insurance plans. Extra
benefits including as prescription medication coverage, dental, vision, and wellness programs are often
included in these plans. Part C is beneficial because it provides more complete coverage alternatives,
which may save individuals money while giving a greater variety of benefits. Finally, there is Medicare
Part D, which provides prescription medication coverage. This portion contributes to the cost of their
prescriptions. I would emphasize how important it is since it guarantees people can afford the drugs they
need, which may account for a big amount of healthcare spending.
Question #2
- Describe 3 key differences between Medicare and Medicaid. Note: Do not repeat the
parts of Medicare described above.
Medicare and Medicaid are both government-funded healthcare systems with substantial
variations. Medicare is mainly intended for seniors aged 65 and over, as well as some disabled persons
who qualify for Social Security Disability Insurance (SSDI). Individuals with end-stage renal disease (ESRD)
are also covered under specific circumstances. Conversely, Medicaid is a federal-state partnership that
provides low-income people and families, particularly pregnant women, children, and adults, with
healthcare coverage. Medicaid eligibility varies by state and is determined by income and other
variables.
Medicare is financed and administered by payroll taxes paid by employees and their employers
throughout their working years. The federal government is in charge of it. Medicaid, on the other hand,
is financed equally by the federal and state governments, with each state having autonomy in
establishing and operating its own Medicaid program. As a consequence, qualifying requirements,
covered services, and benefits differ from one state to the next.
Although both plans provide protection for a broad variety of medical expenses, Medicare's
primary emphasis is on inpatient treatment, outpatient care, and prescription medication coverage (Part
D). Services including doctor visits, hospital stays, long-term care (like nursing home care), and mental
health treatment are all covered by Medicaid. Transportation to medical visits and home and
community-based services are two examples of what Medicaid may pay for something Medicare does
not.
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