Healthcare
Jamie Bishop
Colorado Technical University
Medicare is a governmental program. Specific groups are able to get the insurance in the United States. It is considered a social insurance. It was created by President Lyndon B. Johnson on July 30, 1965. It pays for medical insurance and hospital for the elderly and disabled. There are 2 parts A and B. Part A is the hospital stays including the room, food, therapies that are deemed necessary. Part B is a supplementary medical insurance. It pays for healthcare costs, physician visits as well as home visits. Here is a list of items that it covers:
“Durable medical equipment (canes, walkers, scooters, wheelchairs, etc.)
Physician and nursing services
X-rays, laboratory and diagnostic tests
Certain vaccinations
Blood transfusions
Renal dialysis
Outpatient hospital procedures
Some ambulance transportation
Immunosuppressive drugs after organ transplants
Chemotherapy
Certain hormonal treatments
Prosthetic devices and eyeglasses.” (MediLexicon International Ltd, n.d) Medicaid is run by the state health department and the federal Centers for Medicare. The insurance used a prospective payment. This is where the payment is predetermined and a fixed amount. It is based upon classification system. Payment is picked up after Medicare makes payment. Dual eligibility is where you are eligible for both Medicaid and Medicare. There is two types’ original Medicare or Medicare advantage plan c. To get part D you have to have full Medicaid and Medicare. Part D is the prescription drug coverage. Medicaid sends payments to the health care providers for services rendered. There is an agreement with the doctors’ offices or hospital. Tricare is for men and women that are in the military or retired from the Military. There are four types. The first is Tri-Care reserve select which is for National Guard personal. There is a fee for the service with their spouses. Medicare pays first then any secondary insurances the Tricare kicks in. Tricare Standard has the most flexibility. It is a pay for service coverage. Tricare for Life is for veterans that are eligible for Medicare along There are no enrollment fees and the fees are reasonable. Tricare Extra is the last option. There are no enrollment fees and you can utilize Tricare standard. If you use in network pharmacies there is no deductible and you don’t have to file your own claims. Workers compensation is where company’s purchase if someone gets hurt on a job. There are different Guidelines for each state. Medical costs and hours lost are covered. Damages that are not covered are punitive damages. (Free advice Staff, N.D) Commercial insurance is a type of insurance which is also known as private insurance. Working for a company they offer insurance then deduct from your check. Typically there are several plans you can choose from. Each one has different things that are covered. In most of the plans there is a deductible. In doing my research I would have to say that the plan that has the most rules and regulations would have to be Medicaid and Medicare. The reason I say this is there are so many little ins and outs. I have both and it is so hard to understand everything. They are continually changing the regulations.
