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Introduction. Medicare Parts A (Hospital Insurance): Eligibility
Part A premium-free covers
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People aged 65 years or older
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A patient paid Medicare taxes for a minimum of 10 years when working (Grabowski et al., 2017)
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Must be enrolled for part B
However, one is eligible for the cover without paying premiums if they receive retirement benefits from social security or from Railway Retirement Board.
Medicare Parts A (Hospital Insurance): Covers
Services covered:
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Inpatient care in the hospital and Hospice care for the terminally ill patients
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Home health care as the doctors order and the hospital accepts
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Nursing home care (inpatient care in skilled nursing facilities thats not custodial or long-term care) (Graham et al. 2018)
Services not covered:
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Long-Term Care (also called custodial care) (Grabowski et al., 2017)
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Most dental care and eye exams related to prescribing glasses
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Cosmetic surgery and Acupuncture
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Hearing aids and exams for fitting them
Medicare Parts B (Health Insurance): Eligibility
To be eligible for Part B one must either be:
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65 years old
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Have a disability
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Have end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) (Leifheit et al., 2018)
Generally, Part B covers:
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Clinical research
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Ambulance services
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Durable medical equipment (DME)
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Mental health
Medicare Parts B (Health Insurance): Covers
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Inpatient and Outpatient services
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Partial hospitalization
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Limited outpatient prescription drugs
However, it does not cover:
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Most dental care and eye exams related to prescribing glasses (Graham et al. 2018)
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Dentures and Cosmetic surgery
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Acupuncture
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Hearing aids and exams for fitting them
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Routine foot care
Medicare Parts C (Medicare Advantage): Eligibility and Coverage
Eligible citizens must be registered for Medicare part A and B (Grabowski et al., 2017).
Part C covers:
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Hospital and medical services
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Prescription drugs
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Dental, vision, and hearing services
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Additional services, such as fitness memberships (Leifheit et al., 2018)
Medicare Parts D: Eligibility and Coverage
For one to be eligible:
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They must be enrolled in original Medicare cover (Leifheit et al., 2018)
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Medicare Part D covers add-on prescription drugs.
Add-on prescriptions include:
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HIV/AIDS treatments.
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Antidepressants and Antipsychotic medications (Leifheit et al., 2018).
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Anticonvulsive treatments for seizure disorders.
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Immunosuppressant drugs.
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Anticancer drugs (unless covered by Part B) (Leifheit et al., 2018)
Medigap and supplement insurance
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It is an add-on option
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Eligible for original Medicare members (Leifheit et al., 2018)
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One must not have subscribed for Part C
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Used for covering Medicare costs
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Medicare costs include premiums, deductibles, and co-pays.
Medical Necessity
These are essential medical services. They are provided by a registered healthcare provider. These services aim at establish right treatments
They include:
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Evaluating, diagnosing, or treating an illness
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Treating an injury, disease, or its symptoms.
Limiting charges
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A limit set by law for the amount of a doctor can charge a Medicare patient
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This laws applies to doctor who do not accept Medicare insurance
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It also limits doctor who accepts Medicare partial payment
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The amount is set at 15% more than Medicare amount (Grabowski et al., 2017)
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The limit differs in various states. (Graham et al. 2018)
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Some states limit further.
Process of patient registration
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Registration is by filling a form.
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A patient should write their basic personal information
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The patient should sign the form or provide thumb impression (Graham et al. 2018)
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The details are fed to the HIS registration module system
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A unique identification number (UIN) is generated
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The patient is provide with a printed UIN containing, name, address and date of birth (Grabowski et al., 2017)
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Application fee is collected and receipt issued
Medicaid guidelines and eligible groups
Medicaid covers the under-privileged. To qualify for Medicaid, one must be a citizen of the state in question, and be financially handicapped and medically needy.
Eligible groups include:
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Low-income families
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Qualified pregnant women and children
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Individuals receiving Supplemental Security Income (SSI) (Grabowski et al., 2017)
Medi-Medi (Medicare and Medicaid)
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Laws about Medicaid eligibility differ in various states.
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In some states, one must be enrolled in Medicare to qualify for Medicaid (Graham et al. 2018)
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Medi-Medi covers most health concerns
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Medi-Medi is complementary when covering;
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Nursing home care, personal care, and home- and community-based services
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Medi-Medi members automatically receive Medicare Part D.
Medicaid verification
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Medicaid Eligibility Verification System (MEVS) verifies if applicants are eligible (Graham et al. 2018)
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The electric system provides data specific verification
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It helps to reduce claim denials
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It also aims at eliminate Medicaid fraud
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The service can be accessed 24/7
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MEVs provide Mediacid with updated and easy access to eligibility information
References
Grabowski, D. C., Joyce, N. R., McGuire, T. G., & Frank, R. G. (2017). Passive enrollment of dual-eligible beneficiaries into Medicare and Medicaid managed care has not met expectations. Health Affairs, 36(5), 846-854.
Graham, C. L., Stewart, H. C., Kurtovich, E., & Liu, P. J. (2018). Integration of Medicare and Medicaid for dually eligible beneficiaries: A focus group study examining beneficiaries early experiences in Californias dual financial alignment demonstration. Disability and health journal, 11(1), 130-138. Web.
Leifheit, E. C., Wang, Y., Howard, G., Howard, V. J., Goldstein, L. B., Brott, T. G., & Lichtman, J. H. (2018). Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaideligible patients. Neurology, 91(17), e1553-e1558. Web.
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