Kot Task 2

Topics: Health insurance, Universal health care, Health care Pages: 12 (5017 words) Published: July 22, 2012
Medicare part A is hospital coverage for inpatient hospital stays. More specifically, Part A is coverage for critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals. Part A also covers inpatient care in a skilled nursing facility (not supervisory or long-term care), hospice care services and some home health care services. Inpatient care in a Religious Nonmedical Health Care Institution is also covered. In the scenario provided, Mrs. Zwick is admitted to the hospital as an inpatient because she had a stroke. The patient was deemed by the physician to need continued treatment after discharge due to the patient's condition and was discharged to a skilled nursing facility. To determine what coverage Mrs. Zwick will receive from Medicare Part A, one must look at the coverage requirements. Due to a stroke, the patient was admitted inpatient and needed critical access to care. The patient was only an impatient at the hospital for five days. These factors fit the criteria for Medicare Part A coverage for a semi-private room, hospital services, meals, nursing, and supplies, and inpatient mental health care (lifetime limit of 190 days). Medicare part A does not pay the annual Part A deductible amount; and the co-insurance amount that is $1,156 per benefit period. Since the patient was admitted for only 5 days, the patient only has to pay one benefit period. If the patient had needed blood, the cost of the first three pints of blood would not be covered. Moreover, if the patient had been traveling abroad no medical expenses would have been covered under Medicare Part A. For the patient to be eligible for SNF coverage post discharge, the patient had to have either had a qualifying three-day hospital stay or started receiving Medicare-covered SNF care. Because the patient met this criterion, Medicare Part A covered the SNF stay for the first 20 days of her stay based on Medicare Part A coverage stipulations. What Medicare Part A does not cover for the patient's SNF care is the co-insurance amount for each day after day twenty. Since the patient stayed a total of forty days, the patient owes 144.50 per day for the last twenty days of care even though the lengthy stay was due to a hospital-acquired infection. If the patient would have needed home health care, part A does not pay anything for non-medical personal care services and the patient is responsible for 20% of the approved cost of medical equipment or non-skilled care (Medicare Part A (Hospital Insurance), 2012). Medicare Part B is medical insurance that covers treatments or services that are needed to treat or prevent medical conditions that meet recognized standards of medical practice. Medicare Part B would cover equipment that the doctor prescribes the patient to use at home. In addition, medically necessary services like doctors' services, outpatient care, durable medical equipment, and home health services are covered as well as some preventive services. Laboratory services are covered under Part B as well. Other items covered by Medicare Part B include arm, leg, back and neck braces and medical supplies such as ostomy bags, surgical dressings, splints and casts. Breast prostheses following a mastectomy are covered as well as one pair of eyeglasses with an intraocular lens after cataract surgery. Medicare Part B pays for different kinds of durable medical equipment in different ways. Some equipment must be rented and other equipment must be purchased. In most cases, if the patient needed to receive blood, the provider gets blood from a blood bank at no charge, and the patient will not have to pay for it or replace it. What Mrs. Zwick would be responsible for would be the copayment for the blood processing and handling services for every unit of blood given, and the Part B deductible applies. If the provider has to buy blood for the patient, the patient must either pay the provider costs for the first three units of blood received in...

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