Question

Critique the coverage that Medicare Part A, B, C and D provide. Explore one area in Medicare Parts A, B, C and D that EHR can benefit from and defend your answer.

Answer 1

Medicare is primarily known as the United States federal health insurance program that is available to American citizens who are ages 65 or higher, but Medicare also covers other smaller groups, such as people who suffer from a disability. Founded in 1965, Medicare has grown to become the most important provider of health insurance to older Americans.

Medicare is the federal health insurance program for:

• People who are 65 or older
• Certain younger people with disabilities
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to:

• Original Medicare
• Some Medicare Cost Plans
• Some Medicare Private-Fee-for-Service Plans
• Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Health care expenses are one of the least predictable and potentially most expensive parts of retirement planning. Medicare does wonders to introduce some structure to the health care maze, but it is only one piece of the puzzle. To make matters more difficult, the programs within Medicare are quite complex, and most retirees do not entirely understand what their benefits are with Medicare.

Medicare Part A (Hospital Insurance)
Medicare Part A is known as hospital insurance, as it covers hospital expenses like inpatient hospital stays, skilled nursing facility care, and hospice. In addition, Part A covers other services like lab tests and surgeries, as well as necessary medical supplies like wheelchairs and walkers. Medicare Part A is perhaps the most well-known part of the Medicare program because it is provided at no additional cost to retirees (and their spouses) who have paid at least 10 years into the system. But Part A is generally considered emergency coverage, as it is the bare minimum in terms of health insurance coverage.

While it's better than no insurance at all, most retirees opt for additional coverage in the form of Part B.

Medicare Part B (Medical Insurance)
Medicare Part B is known as medical insurance, as it is an extension of the hospital and medical supply/equipment insurance provided by Part A. Part B of Medicare covers preventative care, doctor visits, lab work, and outpatient services such as physical therapy. Part B can also cover costs like ambulance services, mental health services, and some prescription drugs. The most important piece of Part B is that is covers what is considered preventive care, not just the medical necessities of Part A.

To receive Medicare Part B coverage, however, you must be eligible and pay a monthly premium. The amount of the premium varies based on your income, so the more you make in retirement, the higher your Medicare Part B premium will be. But even between Parts A and B, there are still gaps in coverage. For instance, even with Part A and Part B coverage, services like long term care, most dental care, annual eye examinations, and hearing aid services are not covered.

Medicare Part C (Medicare Advantage Plans)
Medicare Part C is commonly known as Medicare Advantage. At a high level, Part C provides an alternative to Parts A and B and usually eliminates the need for Medigap insurance. (Medigap insurance is a commonly selected option for those with Parts A and B. Medigap covers some on the holes in Medicare coverage). Part C is actually offered through private companies that contract with Medicare to provide Part A and Part B benefits. The primary benefit of Medicare Advantage Plans is the choice of organization to contact with (such as an HMO, PPO, Medical Savings Account Plans) as well as the possibility of a more comprehensive prescription drug coverage.

Medicare Part D (Prescription Drug Coverage)
One of the biggest coverage gaps in the Medicare Parts is prescription drug coverage. Established in 2003, Medicare Part D is the newest part and it covers prescription drugs for those who choose to purchase this part through the payment of monthly premiums. Like Medicare Part C, Part D is offered through private companies that contract with Medicare.

To enroll in Part D, you must have either Parts A and B or Part C. Like all insurance policies, there are variations in terms of deductibles.