HEALTHCARE UTILIZATION

Healthcare Utilization and Finance

Healthcare Utilization and Finance

Question A

Medicare A

Medicare Part A benefits are commonly referred to hospital. The main benefits of which under this plan are in hospital intensive care, rehabilitation hospitals, long-term care, and mental health services. Other benefits include short-term care in a skilled nursing facility, terminal care delivered through a Medicare approved provider of hospice and home health care services.

Medicare Part A eligibility requires participants to be 65 years old and a U.S. citizen. In some cases, those under 65 with certain disabilities, and actual work will also be entitled to claim benefits (Victoria, 2009).

Medicare B

Medicare Part B for physician and other services outside the hospital provided. Medicare Part B is the section that deals with health insurance coverage of physician visits, home health services, outpatient care and various other medical services. Seniors who do not enroll in Medicare Part B when they are first kept; they may require paying a late fee when they send the documents. Part B covers two types of medical care and medical services necessary preventive services. Medically necessary services include services and supplies that are needed to diagnose and treat the problems of a patient (Victoria, 2009). These items must also meet accepted standards of medicine. Prevention services are services that are performed to prevent disease or detect disease at an early stage, when the treatments available are highly likely to work efficiently.

Medicare D

Medicare Part D covers prescription drugs for people on traditional Medicare. People purchase Medicare Part D prescription drug coverage from Medicare approved insurance companies. There are different levels of coverage of prescription drugs. The total cost includes the monthly premium policy, the deductible amount and copayment. Monthly premiums vary by the level of coverage. The deductible is the amount of money to the Medicare beneficiary must pay for the prescription drug before the policy begins to Part D payment. The government regulates Medicare deductible amounts (Victoria, 2009).

Medicare Part development plans may have different levels of coverage, require prior authorization, and have a coverage gap. Tiers or levels of the coverage generally classify prescription drugs in different categories according to cost. Depending on the plan chosen, some drugs cannot be covered. Therefore, make sure to choose the level that pays for the necessary requirements. Other plans may require prior authorization before paying for some drugs. For example, Medicare Part D cannot pay for a prescription expensive when there ...