Medicare is a complex medical insurance program Essays

Medicare is a complex medical insurance program Essays Medicare is a complex medical insurance program Paper Medicare is a complex medical insurance program Paper Essay Topic: Medical Medicare is a complex medical insurance program that is intended to cover to some certain extent medical expenses of those insured by it. Medicare insurance program is developed for people who reached age of 65 or older. People under 65 with certain disabilities and patients with end stage renal disease are also insured by Medicare. Medicare consists of several more or less independent components, or parts. Most basic of these components are Medicare part A and Medicare part B. Medicare part A will help cover expenses for inpatient care. This is very helpful for people over 65. People of this age have increased risk of considerable number of acute diseases emerging, such as myocardial infarction, pulmonary embolism, stroke, pulmonary edema and several other life-threatening conditions that can be properly managed only by skilled health care professionals in a hospital. Intensive treatment of such pathologic conditions requires relatively short period of time with subsequent period of observation and rehabilitation, which is usually more extended than initial period of intensive care. Still, total amount of time spent in hospital and rehabilitation centers rarely exceeds 60 days – the limit of 100%-coverage of all insured patients medical expenses for a single spell of illness. Patient needs only to pay single deducible, and the rest will be paid by Medicare. Even if the patient has to stay in hospital for more than 60 days, beneficiary of Medicare insurance is eligible for coinsurance program. Coinsured patient pays certain sum for every day he stays in a hospital, and Medicare pays for everything that exceeds this sum and is medically-necessary for the patient. Coinsurance program lasts for 30 days, and, if even longer hospital care is needed, patient has the right to use part of his â€Å"lifetime reserve† of insurance, which comprises another 60 days. During this lifetime reserve days sum for patient to pay for a day increases comparing with the sum payed for a day during coinsurance period, but Medicare will still pay the rest of medically-necessary expenses. Only when lifetime reserve will exhaust patient should pay full price for care and treatment he needs. But total time covered by initial and subsequent programs of Medicare part A comprises 150 days, which is usually more that enough. People over 65 also frequently have certain chronic diseases, that may need hospital or nursing care during exacerbation period. Apart from inpatient hospital stay, Medicare part A also covers stay at skilled nursing facilities (which provide medically-necessary rehabilitation and nursing care), psychiatrid inpatient care, home health care and hospice care. The same scheme of 100% coverage, coinsurance and lifetime reserve is applied for services listed. Medicare part B is the part of Medicare insurance program that covers certain considerably broad range of services that arent covered by Medicare part A. According to Smith (2008b), services covered at present time are physician and surgeon fees, outpatient services, immunosuppressive drugs, blood service (after the first three pints of blood in any calendar year are payed for), clinical laboratory services, some coverage for outpatient mental health visits, and ambulance service. This coverage is available providing the patient pays certain sum of monthly premium that gives him access to the Medicare part B services. Amount of this premium is rather small comparing with total amount of money required to pay for services covered if one has no insurance. There is a list of services that are excluded from coverage, however, but these services are not critical care services and are rather matter of choice for the patient. Medicare provides coverage of medically-necessary treatment and care. Medically-necessary services are those that are needed for the diagnosis or treatment of patients medical condition and meet accepted standards of medical practice. Therefore, almost all medical needs and expenses to manage life-threatening conditions and exacerbations of chronic illnesses that are not uncommon for people over 65, will be covered completely or, at least, partially. References: 1. Smith, F. (2008). Medicare part A. Retrieved December 28, 2008, from medicare. org/index. php? option=com_contenttask=viewid=15Itemid=49 2. Smith F. (2008). Medicare part B. Retrieved December 28, 2008, from medicare. org/index. php? option=com_contenttask=viewid=16Itemid=50