Medicare Parts essay

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Medicare has four different parts that help to cover specific medical services:

Medicare Part A

Medicare Part A is health insurance provided by Medicare and covers hospital inpatients and skilled nursing facility (Medicare.gov, n.d.). People qualify to receive Part A’s hospice and home health care only if they meet certain requirements (Medicare Consumer Guide, 2012). It is important to note that Medicare neither covers everything, nor the total cost for many of the services it covers. Medicare Part A covers the following: It covers blood transfusion services one receives when staying in hospital.

Hospital stays

Medicare Part A covers meals, rooms, general nursing and other hospital services encountered during the stay at the hospital. Critical access hospitals’ inpatient care and mental health care up to a maximum of one hundred and ninety days are also covered. Hospital stays are covered up to three days; this time is calculated from the first midnight after admission excluding hours on the discharge date (Centers for Medicare & Medicaid Services, 2012).

Skilled nursing facility

This normally depends on the type of diagnosis one receives during his/her stay at the hospital. It covers costs related to semi-private room, meals, skilled nursing services and care and rehabilitation services. The care covers up to a maximum of one hundred days, the first twenty days being paid in full, and the remaining eighty days co-paid.

Home health services

Home health services cover part-time care including care from a skilled nurse, physical or occupational therapy, medical social services and health home services aids (Leonard, 2008). It also caters for medical equipment used at home such as wheel chairs, walkers, oxygen gargets and beds.

Hospice care

This covers patients whose sicknesses are severe that they only remain with at most six months to live (Ship Resource Guide, 2010). Medicare Part A covers expenses related to drugs that relieve pain and control symptoms, counseling and guiding on grief and other related services. This is normally done by professionals approved by Medicare to visit such patients at home.

Medicare Part B

Medicare Part B is provided by federal government and covers the services of doctors, outpatient care, preventive services and other services not covered by Part A (Medicare.gov, n.d.). It covers the following services:

  • Laboratory tests and screenings;
  • Preventive services that help to prevent, manage and diagnose a medical problem such as laboratory tests and screenings;
  • Glaucoma tests once a year. This applies when the test is done by a legal eye examiner;
  • Measurement of bone mass to know where a patient is at a high risk of broken bones. This is normally covered for every two years.
  • Blood and urine tests
  • Cancer screening to find out if there is any cancer growth. The tests include blood tests for annual fecal occult, colonoscopy screening, flexible sigmoidoscopy and barium enema (Medicare Consumer Guide, 2012).
  • Blood screening for diabetics for patients with high blood pressure, obesity or high amounts of sugar in the blood
  • Diabetic supplies and self-management
  • Cardiovascular screening

Part B also covers hospital, doctor and health care. They include part-time home health services such as care from a skilled nurse, physical or occupation therapy and social medical services. It also includes equipment used at home such as wheelchairs, beds, walkers, oxygen gargets and other related equipment. Other services covered include chiropractic, ambulance, blood transfusion and surgery; services for emergency rooms such as those with severe injuries, or endangered life, one pair of eyeglasses and standard frames for those who have undergone cataract surgery.

Preventive shots to prevent flu and hepatitis B are also covered by Medicare Part B. Other services covered include examination of hearing balance, mammograms, dialysis, pap tests or pelvic exams, health care for mentally challenged, therapy for medical nutrition, hospital services, surgery of outpatients, drug prescription, transplant and practitioner services and physical therapy.

Medicare Part C, also known as Medicare Advantage, covers what both Part A and Part B cover. It consists of networked clinics, doctors, hospitals and patients who are required to seek services from only within the network. It normally covers drug prescription but if a person is already covered for prescription medication, he/she can enroll for a Part C plan that does not cover prescription medication (Medicare.gov, n.d). This is because there are many different options to choose from, such as Medicare Health Maintenance Organization (HMO) plan which allows patients to visit doctors or specialists only in the HMO network, Medicare Preferred Provider Organization (PPO) plan which allows patients to seek services from either within their PPO network or outside their network though it costs more, Medicare Private Fee-for-Service (PFFS) plan which does not require patients to seek for a referral in order to see a specialist outside their PFFS network, and special needs plan which is designed for certain population e.g. people living in certain institutions, those eligible for both Medicare and Medi-Cal and those with chronic conditions (California Health Advocates, 2010).

Difference between this plan and Part A and Part B plans is that this plan is also covered by private health insurance companies approved by Medicare. Some Medicare Part C plans provide extra benefits at extra costs. It provides extra benefits besides those offered by the original Medicare. Some have their copayments lowered than the original Medicare but some charge either the same or more than the original Medicare (Gold, Hudson, Jacobson, & Neuman, 2010).

Medicare Part D

Medicare Part D, also known as Medicare Prescription Drug Coverage, is provided by private insurance companies approved by Medicare (Medicare.gov, n.d.). One can join Medicare Part D plan by either adding it to his/her original Medicare plan, by paying a separate premium, or joining HMO or PPO plans that cover Part D. It covers medical prescription differently from plan to plan depending on the insurance company (eHealth, 2012).

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