... Medicare is a national social insurance program, administered by the U.S. federal government since 1965, which guarantees access to health insurance for Americans ages 65 and older and younger people with disabilities as well as people with end stage renal disease (Medicare.gov, 2012). Medicare is a program that offers everyone a well defined benefit that includes different hospital parts. The Medicare parts are: Part A, Part B, Part C & Part D. Part A is known as hospital insurance. This part covers medical necessary such as hospital stay, nursing home, home health care and also hospice care. Medicare Part A is free to people who have worked and paid in Social Security for at least 10 years. There will be a monthly premium charge if you have not worked for at least 10 years and paid Social Security taxes. Part B is medical insurance that covers things such as doctor visits, medical equipment and various other forms of other outpatient services. Part B also covers mental health care and ambulatory services. To receive the Part B medical insurance you have to pay a monthly premium. Part C is the portion of your policy that allows private insurance companies to cover your medical expenses. This includes private health plans such as HMOs and PPOs. To cover the Part A and Part B benefits, Medicare offers a choice between an open-network single payer health care plan and a network plan where the federal government pays for private health coverage (Medicare.gov...
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...CENTERS FOR MEDICARE & MEDICAID SERVICES Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about: • What is a Medicare Supplement Insurance (Medigap) policy • What Medigap policies cover • Your rights to buy a Medigap policy • How to buy a Medigap policy This guide can help if you’re thinking about buying a Medigap policy or already have one. 2013 Developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC) How to use this guide There are 2 ways to find the information you need: 1. The “Table of Contents” on pages 3–4 can help you find the sections you need. 2. The “List of Topics” on pages 53–56 lists topics in this guide and the page number of where to find them. Who should read this guide? This guide helps people with Medicare understand “Medicare Supplement Insurance” policies (also called Medigap). A Medigap policy is a type of private insurance that helps you pay for some of the costs that Original Medicare doesn’t cover. Table of Contents Section 1: Medicare Basics 3 5 A brief look at Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 What is Medicare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 The different parts of Medicare . . . . . . . . . . . . . . . . . ...
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...comprehensive health insurance reforms that will roll out over four years and beyond. Use the links below to learn about what’s changing and when: OVERVIEW OF THE HEALTH CARE LAW 2010: A new Patient's Bill of Rights goes into effect, protecting consumers from the worst abuses of the insurance industry. Cost-free preventive services begin for many Americans. See More 2010 Changes. 2011: People with Medicare can get key preventive services for free, and also receive a 50% discount on brand-name drugs in the Medicare “donut hole.” See More 2011 Changes. 2012: Accountable Care Organizations and other programs help doctors and health care providers work together to deliver better care. See More 2012 Changes. 2013: Open enrollment in the Health Insurance Marketplace begins on October 1st. See More 2013 Changes. 2014: All Americans will have access to affordable health insurance options. The Marketplace allows individuals and small businesses to compare health plans on a level playing field. Middle and low-income families will get tax credits that cover a significant portion of the cost of coverage. And the Medicaid program will be expanded to cover more low-income Americans. All together, these reforms mean that millions of people who were previously uninsured will gain coverage, thanks to the Affordable Care Act. See More 2014 Changes. 2010 NEW CONSUMER PROTECTIONS • Putting Information for Consumers Online. The law provides for where consumers can compare health insurance...
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...Understanding Aetna Medicare Supplements Aetna Inc. controls subsidiary insurance companies that go by the brand name Aetna. The Medicare Supplement Insurance plans from this particular brand are insured by Aetna Health and Life Insurance Company. The big question is: what are these Medical supplement plans? How do they work? Who qualifies to enroll? What are the best options of Medicare supplement plans? Why do you need to enroll for the Medicare supplementary plans? When should I apply for the Medicare supplementary plans? Here is a dissemination of all the answers to these questions. What are Medicare supplementary plans? Medicare supplement plans, also commonly referred to as Medigap Insurance Policies, are designed to complement the Original Medicare Plan. If your Medicare Plan covers about 80% of your medical expenses, the Medicare supplement plans will go an extra mile in covering a certain percentage of the remaining 20% depending on the kind of Aetna Medicare supplement plan that you purchase from Aetna. The Medicare supplement plan will cover for copayments, coinsurance, yearly deductibles, and medical treatment costs that you incurred while outside the U.S. There is a difference between a Medigap Insurance policy and a Medicare Advantage Plan. The latter...
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...EFFECTS ON ENROLLMENT IN THE MEDICARE ADVANTAGE INSURANCE PLANS IN THE STATE OF TEXAS. Medicare is an insurance program provided by the federal government for people who are 65 years old or older, people of all ages with End-Stage Renal Disease, and certain disable people. Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Medicare has become America's leading health care insurance program, providing coverage for approximately 47 million individuals and costing more than $516 billion a year. Medicare nowadays is facing high popularity and an uncertain future. Some experts say that Medicare is expected to go bankrupt in 2017 (Clark, 2009). A Medicare Advantage Plan is another health coverage choice that eligible beneficiaries may have as part of Medicare. The plan is offered by private companies approved by Medicare. MA plans must cover all of the services that Traditional Medicare covers except hospice care. These plans are not considered supplemental coverage but may offer extra coverage such as vision, hearing, dental and/or health and wellness programs. Most include Medicare prescription drug coverage. Medicare pays a fixed amount for the beneficiaries every month to the companies offering the plans. These companies must follow the rules set by Medicare. The motivation to choose this topic comes from an internship or curricular practice training performed during the years 2010...
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...Financing and Structuring Health Care Assignment #2 Health Services Organization – HSA 500 1. Identify and describe the three main types of health insurances in the U. S. The three main types of are Voluntary Health Insurance (VHI), Social Health Insurance, and Public Assistance or Welfare medicine. Each type of health insurance provides medical benefits which provide payment for medical services rendered. Voluntary health insurance (VHI) can be divided into three categories: BCBS, private or commercial insurance companies and Health Maintenance Organizations (HMO). VHI began in 1929 when Baylor teachers in Dallas, Texas contracted with Blue Cross to provide hospital coverage for three cents a day. This was the beginning of hospital coverage provided by an insurance company. Other states began to provide this same type of coverage for their employees. Since this time health coverage has been extended to provide benefits for physicians, pharmacies and other medical providers. More than 70 years later over 70 percent of the US population under age 65 has some form of VHI, and more than 90 percent of these have health coverage linked through employment. The United States mandates two social health insurance (SHI) programs: Workers Compensation which covers the cost associated with job-related injuries, and Medicare which provides health insurance for the elderly, disabled and other special groups. Workers Compensation provides two basic benefits: cash replacement for...
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...Healthcare System, Briefing Paper- 2 Name: Dilpreet Singh What is Medicare? What are the components and how are they financed? What are the problems facing Medicare? What are your solutions? Medicare: Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Administered by the US government since 1966, Medicare is currently using 30 private insurance companies across United States. In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and 8 million younger people with disabilities. On average, Medicare covers about half (48 %) of the health care charges for those enrolled in Medicare. The enrollees must then cover the remaining approved charges either with supplemental insurance or with another form of out-of-pocket coverage. Components of Medicare: Medicare has four parts. These different parts help cover specific services. Medicare PART A (Hospital/Hospice Insurance): Part A covers inpatient hospital stays including semiprivate room, food, tests, care in a skilled nursing facility, and hospice care. (Hospice care focuses on palliation of seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs) Medicare PART B (Medical Insurance): Part B medical insurance covers certain doctors' services, outpatient care, medical supplies...
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...Donnie Tatar University of Michigan HSM544: Health Policy and Economics As the newly appointed chief of staff I have been tasked with responding to a proposal for reducing Medicare expenditures by enrolling participants in HMO. I understand that we have some key questions must be addressed and that we must justify our position on either economic efficiency or equity grounds. Outlined below are some of the questions that must be answered in order address this issue properly. Is Medicare in a state of crisis? Are you aware of the various policies that are being enacted from each state to state regarding the qualification of Medicare? Medicare is funded by the federal government and each state is responsible for operating the Medicare program as well as the local Medicaid programs. However, premiums have increased for Medicare and also, the coverage has changed in the past few years requiring people to purchase additional supplemental Medicare policies - this is difficult for elderly that have fixed incomes. If the elderly are unable to purchase Medicare, they will go uninsured. The Medicare system is double-funded. It is funded by the taxpayer (federal dollar) as well as the premiums being collected. But, in being double-funded, the coverage is still not as high as most private insurance companies making them appear with less quality. Are radical measures necessary to preserve the program? This is a very interesting question and you will have to take a more subjective...
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...benefits of the Medicare system while exploring the many challenges of the program. The United States Medicare program is the closest program to universal health care for one portion of the population. While providing some level of health care to most elderly citizens over 65 years of age, it sometimes is found to be highly confusing to its patients. Additional concerns explored by this paper relate to the costs, quality of care, and availability to all who need this insurance. When all of the pros and cons are explored, one final concern arises. Amid the rising costs of medical care, prescription drugs, and costs of program administration, will the funding of this program continue and will this be a program that the young families of today can depend upon for their retirement years? 1. Introduction: The rules and regulations of Medicare Simply stated, Medicare is the federally financed health insurance program for people aged 65 and over, certain individuals with disabilities, and individuals with end-stage renal disease. Medicare Part A covers hospital and other inpatient stays. Medicare Part B is optional insurance, and covers hospital outpatient, physician, and other services. Medicare Parts A and B are known as original Medicare or Medicare FFS. Medicare beneficiaries have the option of obtaining coverage for Medicare Part A and B services from private health plans that participate in Medicare's MA program, also known as Medicare Part C. All Medicare beneficiaries...
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...Health Care Utilization Paper (Option A) Tammy Zoch Instructor Rebecca Loth Luetke HCS/235: Delivery of Health Care in the U.S. 29 April 2013 Thesis Statement The Health Care Reform is a complex issue and is a hot topic nationwide that has the government, health care facilities and providers, insurance companies, health care employees and Americans talking about the law with its advantages and disadvantage affecting the delivery of health care. Health Care Utilization Paper (Option A) The Patient Protection and Affordable Care Act was signed into law by President Barack Obama on March 23, 2010, along with the Health Care and Education Reconciliation Act of 2010 signed on March 30th. The Act is a product of the health care reform efforts of the Democratic 111th Congress and the Obama administration (Wikipedia, Health Care Reform,2013), putting in place comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law allows all Americans to make health insurance choices that work for them while guaranteeing access to care for the most vulnerable, and provides new ways to bring down costs and improve quality of care (The White House, 2013), to take effect and be completed in 2014. According to the website www.healthcare.gov, the Health Reform is already making a difference by increasing access to affordable care, making care more affordable, strengthen Medicare, holding insurance...
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...BEO2401: Risk Management and Insurance Major Assignment A historical analysis of health insurance in Australia Due Date: 22/5/13 Class: Wednesday 11pm tute Jeremy Fung 3897865 Kwin Trieu 3795138 Tamimuddin Saadzadah 3854247 Zaker Hussaini 3887002 Executive Summary The aim of this report is to analysis and review the Australian Health Care System, We have had a look at the history of the healthcare system in Australia and how it started out in 1901 after the formation of the commonwealth government and the Constitution and the power sharing of the responsibilities and control of the health sector between the federal and state government. The report also analyses the dual private and public health care system, which is the Medicare and the Private Health Insurance (PHI) options for Australian Citizen. The other are that we have reviewed is the legislations related to the health Insurance sector and why is the government so keen in keeping the Private Health Insurance capacity high and what are the benefits of the PHI for the government and the health industry finance. Table of Contents Introduction 1 Australian Health Care System 2 1.1Health Insurance (History) AND Recent Changes in Private Health Insurance 2 1.2 Medicare and the Decline of Private Health Insurance (PHI) Challenge for the Government 3 1.3The role of Private Health Insurance in Australian Healthcare...
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...Medicare Project Author Note In 1965, U.S. President Lyndon B. Johnson passed the Medicare Benefit legislation as an amendment to the Social Security Legislation after 20 years of debating. Medicare is a health insurance program for U.S. citizens at least 65 years old, or those aged younger than 65 years who suffer from certain disabilities. In 1965, nearly half of the elderly had no health insurance and many others did not have enough coverage. That is when Medicare was enacted to help assure that almost all citizens at the age 65 or older would have health care coverage. The program was modeled on the standard employer sponsored health plans of the day. As the Nation moves into the 21st century, Medicare is facing serious financial challenges. Over the next 50 years the number of beneficiaries are expected to more than double while the ratio of workers, whose payroll taxes fund over half of the program, to beneficiaries is expected to decline from about 4 to 1 to a little over than 2 to 1. In recent estimates from the Congressional Budget Office and the Administration predicted that the program will be bankrupt about the time the growth in beneficiaries accelerates as the baby boom generation started to become eligible in 2010. People seem to get Medicaid and Medicare confused. Medicare and Medicaid are both government sponsored programs designed to help cover healthcare costs. Both programs were established by the U.S. government in 1965 and are taxpayer funded, they...
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...assignment of benefits patient's written authorization giving the insurance company the right to pay the physician directly for billed charges birthday rule used by insurance claims administrators to determine which parents plan will pay for the medical bills of a dependent child when the child is covered by plans of both parents capitation rate predetermined amount paid to provider every month regardless of the number of times the patient is seen within the month claim written and documented request for reimbursement of an eligible expense under an insurance plan. Clean Claim health insurance claim form that has been completed correctly without any errors or omissions Clearinghouse independent entity that reviews claims, requests clarification from the provider, and "cleans" claims, ensuring accurate information is documented, then submits claims to insurance companies in proper format CMS-1500 most common health insurance claim form used to file claims for physicians services Co-Insurance cost of claims shared by insurance company and insured after deductible Coordination of Benefits procedures to prevent duplication of payment by more than 1 insurance carrier Co-Payment predetermined amounts of money the patient must pay for medical services at every visit, as determined by the insurance company. Crossover Claim patient claIM THAT IS ELIGIBLE FOR BOTH MEDICARE AND MEDICAID; ALSO KNOWN AS MEDI/MEDI Deductible amount...
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...Module 2 Assignment 1: Exploring U.S. Health Care Expenditures Name: Edward Hamilton 1. Year for which data is presented 2013 Total dollar amount for expenditures $ 2.9 trillion (1 pt) | 2. Explain how national health expenditures vary from governmental spending on health care. (2 pts) National health expenditures (NHE) comprise of all expenditures from all payer sources (individual and institutional) of which governmental spending is just one component of the NHE total. For example, an insured’s copay as well as a hospital’s new cancer center construction costs all count towards the NHE total. Governmental spending is limited to expenditures from the public sector (i.e. Medicaid, Medicare, VA and single disease funds) ( | The Nation’s Health Dollar 2013: Where It Went(Expenditures Table) | Category of expenditure | % allocated to this category (1 pt each) | | Answer the questions below including citations to your sources. (3 pts each) | Program administration and net cost | 3a. 7% | | 3f. What does this category include? “Administrative costs of the health insurance system include (a) spending by public and private health insurers other than actual payments to providers and (b) costs incurred by other system participants, including providers, employers, and...
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...healthcare an an antidotes to many disease process, this has been able to achieve due to the new healthcare technologies to tackle many diseases that were affecting citizens. In this modern day, it is apparently clear that the healthcare is one of the largest employer of labor according to the text (Williams and torrens, 2010) introduction to health services organization and management. The United States federal government have spent significant amount since the advent of Medicare in the country, in the late 1960s to date and this has rapidly grown to date. 1 – Identify and describe the three main types of health insurance in the U.S. The three main types of health insurance available in the U.S. today are voluntary health insurance, social health insurance and welfare medicine. Voluntary health insurance is subdivided into three categories. The first is Blue Cross Blue Shield which began as separate companies. Blue Cross began in 1929 and Blue Shield dates back to 1939, they joined each other in operation in 1982. Blue Cross Insurance can be found in every state within the U.S.Blue Cross Blue Shield is a privately owned company and is offered through...
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